Cervical exenteration is a radical procedure for the treatment of locally invasive cancers of the trachea, esophagus, or thyroid, as well as recurrent tumors at the site of a tracheal stoma, and occasionally for benign disease. Exenteration involves removal of the larynx, pharynx, esophagus, and trachea, as well as associated lymphatic tissue. The tracheal stump is brought up as a cervical or mediastinal tracheostomy, depending on the length and the location of the distal resection site. The alimentary tract can be reconstructed with several types of conduits, but most commonly the stomach or left colon are used. Tension on the innominate artery must be avoided when repositioning the trachea to prevent innominate artery erosion. Tension on the artery can be addressed by either dividing the vessel or by transposing the trachea inferior and lateral to the innominate artery and vein. Overall, cervical exenteration is associated with a significant risk of morbidity, including anastomotic leak, innominate artery erosion, and tracheostomy dehiscence with subsequent mediastinitis, as well as the potential for postoperative death. Nevertheless, in highly selected patients, it can provide an unparalleled opportunity for either cure or palliation, with functional results equivalent to that of total laryngectomy.