Airway compromise is the most significant complication of a postoperative neck haematoma. Here, we report the management of a case of complete airway obstruction secondary to an acute neck haematoma arising after radical neck dissection, partial glossectomy and a free flap reconstruction. The patient deteriorated precipitously and required immediate emergency surgical front of neck access to secure the airway. Drawing on our experience of this case, we propose a mental model to inform the emergency airway management of postoperative neck haematoma following all types of surgery.