We report a case of a patient who suffered a near-fatal tracheal extubation following anterior cervical spine surgery. Dislocated surgical material had compromised his airway in such a manner that subsequent tracheal re-intubation was unsuccessful. Only bag/valve/mask ventilation and emergency tracheostomy saved his life. Although clinical symptoms indicated the possibility of post-extubation problems, tracheal extubation was still performed. Hypersalivation should be regarded as an early sign of oesophageal and/or airway compromise, and should not be dismissed. Before attempting extubation, these patients should undergo laryngoscopy and radiograph of the cervical spine or computerised tomography (CT) scan to exclude oedema and surgical material dislocation.