Involvement of the carotid artery in tumours of the head and neckCarotid artery involvement in neck tumours causes great concern to surgeons because of the unpredictable effects of carotid artery clamping or excision. Various methods of pre‐ and peroperative assessment of crossover cerebral circulation are reviewed. The management of 3 cases with extensive tumour involving the carotid artery is described. This comprises a combined operation involving a head and neck surgeon and vascular surgeon using a temporary carotid shunt followed by permanent autogenous vein graft to the internal carotid artery. It is suggested that thorough preoperative investigation combined with a more radical surgical approach can give a more satisfactory outcome in cases of head and neck tumours involving the carotid arter