Abstract Patients undergoing head and neck surgery for malignancy especially resection of parts of the upper aerodigestive tracts need a secure airway intra- and postoperatively. A tracheostomy is an effective method of achieving this objective. In our unit the Bjork flap technique' has been the preferred type of tracheostomy. Ninety-five consecutive Bjork flap tracheostomies performed by one surgeon preceding major head and neck resection for malignancy in patients aged 17–79 years (median = 61 years) were retrospectively evaluated. The technique was quick and provided a secure airway. The tracheostomy tubes were left in situ for a median of 5 days (range 1–17 days). After extubation subsequent stoma closure was uneventful, 60% healing within 1 week. No patient developed tracheal fistula, clinical tracheal stenosis or cosmetically unacceptable scarring. There was no tracheostomy-related mortality. It is concluded that the Bjork flap tracheostomy technique can be safely used in head and neck cancer surgery in adults.