The development of a stomal recurrence after temporary tracheostomy for malignant disease of the head and neck is a rare complication, but is a well-recognized phenomenon following total laryngectomy. The risk factors and mechanisms involved are still not well understood. In a review of 265 patients having a temporary tracheostomy for head and neck malignancy, three (one per cent) developed a stomal recurrence. All recurrences occurred in the group where tracheostomy had been performed pre-resection and of these three patients all had N+ disease. The findings suggest that tumour-cell implantation is an important mechanism of stomal recurrence and that operative technique and timing of tracheostomy placement is important in reducing the risk of encountering this complication.