Tracheal aspiration, a leakage of food or saliva into the trachea, can be developed after various head and neck surgery, especially after resection of the tongue, pharynx, and larynx with tumor. To handle this serious postoperative problem, tracheostomy is routinely carried out customarily not only to keep an airway but also to remove the aspirated materials. But tracheostomy needs insertion of cannula, so many complications could follow. Instead of tracheostomy, tracheal fenestration was performed in the cases of predicting postoperative tracheal aspiration after head and neck surgery. The fenestration was made by I-shaped cartilaginous incision on 3rd and 4th tracheal ring, and suture was done between tracheal mucosa and skin. The fenestrated opening was closed after completion of swallowing training. The results comparing the effect of tracheal fenestration with tracheostomy could be summarized as follows ; 1) Tracheal aspiration disappeared within average of 14 days after beginning of swallowing training. 2) The closing of tracheal fenestra was performed on the average time span of 3 month and 21 days. 3) Tracheal fenestration was better than tracheostomy in following respects of cannula insertion, suctioning and expectoration, wound infection, direct visualization of aspiration, and phonation.