Carotid artery rupture hemorrhage is a rare but dangerous clinical emergency, often caused by trauma, tumor and other diseases, with acute morbidity and high mortality, timely resuscitation can save the patient’s life, but untimely treatment can easily lead to hemiplegia or even death. For trauma patients with timely compression, surgical vascular anastomosis or interventional placement of vascular stent can be performed. In contrast, carotid artery rupture due to tumor causes is mostly treated with carotid ligation to achieve hemostasis. Carotid artery rupture haemorrhage is the most serious postoperative complication in head and neck surgery, and untimely resuscitation with large bleeding volume often leads to patient’s death. Ligation or resection of the internal carotid artery or common carotid artery may result in serious cerebrovascular comorbidities and even death. Whether death or hemiparesis occurs after surgery depends critically on the variability of the ring of the fundic arteries (Willis ring), which is composed of the bilateral internal carotid arteries and vertebral arteries, and which connects the anterior and posterior groups of the great arterial system. However, anatomists have found many normal variants of the ring. According to statistics, about 53.8% of Willis rings have normal morphology, symmetry on both sides, and each artery is patent. In our data, about 3.7% of Willis rings are uncircled (open type). When carotid artery rupture occurs in those who do not have a ring, hemiparesis or death can easily occur. There are few reports of cases of carotid artery rupture with hemorrhage in China and abroad, and there are several emergency management options: ligation of the common or internal carotid artery, interventional carotid embolization, and interventional placement of stents in the carotid artery. The exposure of the carotid artery after the occurrence of pharyngotracheal fistula was found to be a very noteworthy problem in clinical work, and the color change of the carotid artery surface during the change plays a crucial predictive role. A gradual change in the surface color of the carotid artery from gray to red indicates a decreasing likelihood of arterial rupture, while a gradual change in color from gray to yellow or gray-black indicates an increasing likelihood of carotid artery rupture. Once the possibility of carotid artery rupture is considered, the following preparations should be made: First, prepare a tracheal cannula with a capsule at the bedside, which can be inserted into the trachea and inflated in case of rupture, which can play a role in the possibility of suffocation caused by hemorrhage into the trachea. Secondly, a bedside suction device should be prepared so that once the blood is instilled into the trachea, the blood in the trachea can be sucked out as soon as possible while pressing the bleeding site to restore normal breathing. Third, prepare a medication change kit at the bedside in case of urgent need. Fourth, all doctors and nurses in the department must be made aware of the potential dangers of patients with hemorrhage, and at the same time, the patient’s condition must be explained to the patient’s family, and the family must be made aware of the method of pressure on the bleeding site so that the problem can be prevented before it occurs. It is important to note that carotid artery ligation should be performed in the non-infected area as much as possible. If the carotid artery is ligated in the infected area, it must be thoroughly cleared, and it is best to apply fresh myocutaneous flap tissue to cover the wound to promote early healing of the wound. Aura bleeding also plays a crucial role clinically. In the event of one or two sudden wound bleeds in patients with pharyngeal fistula changes, it is important to check whether the carotid artery has been exposed and shows aura of bleeding, which occurred in close to 50% of the patients in this group, a phenomenon worth noting. In addition, despite the fact that patients with carotid artery rupture hemorrhage are in poor physical condition and do not seem to recover easily, especially those who feel more seriously ill, doctors must have firm confidence in treatment and not give up on resuscitation, such as the particular case in this group, which is an example of such a phenomenon. In conclusion, carotid hemorrhage is a more serious postoperative complication in head and neck surgery, which often occurs after high-dose radiotherapy or after multiple operations and after surgery for patients with extensive tumor invasion. Once it occurs, the judgment should be accurate and the resuscitation should be rapid. Timely arterial compression to stop bleeding and keep the airway open is the key to successful resuscitation. Carotid artery ligation, interventional embolization of artery, stent artery reconstruction and other resuscitation methods can be used.