A case of Madelungs neck is reported. After two operations in three years the patient developed respiratory insufficiency and transferred to our hospital in state of severe suffocation for tracheotomy. The factors leading to suffocation, such as inspiratory dyspnea, factors influencing the patient to undergo an operation and therapy, and difficulties encountered by an ENT surgeon in managing a respiratory crisis by tracheotomy are highlighted. The reported case illustrates an emergency tracheotomy in a very advanced stage of the disease.