An unusual cause of stridor following anaesthesia requiring tracheostomy.

A 75-year-old woman underwent panendoscopy and excision of a neck "lump". After antagonism of residual neuromuscular block and extubation of the trachea, she developed recurrent upper airway obstruction and stridor, necessitating a permanent tracheostomy. The possibility of vagal nerve involvement or injury should always be considered during excision of neck lumps. Preoperative indirect, atraumatic laryngoscopy by experienced surgeons is essential, as are tracheal intubation and vigilant postoperative observation.