Abstract: Objectives: Carotid blow-out syndrome (CBS) is one of the uncommon yet detrimental complications in head and neck cancer patients, by presenting itself as a catastrophic bleeding. Various factors are related with CBS. There is no timeline for the development of CBS in patients with uncontrollable tumors. In this report we intended to review our cases of CBS with special emphasis on risk factors, the timeline for carotid rupture as well as the outcomes following ligation. Design, Setting and Participants: A retrospective analysis was performed on previously treated head and neck cancer patients who experienced carotid blow-out syndrome (CBS) following tumor recurrence between 2015 and 2020. Results: All of the patients in this study were classified as type III CBS and managed by carotid artery ligation. Three patients had previous chemoradiotherapy while five had surgery and adjuvant treatment as the primary treatment. Time to recurrence following primary treatment was ranging between 6-19 months with a mean of 8.25±5.11 months. Apart from tumor infiltration seen in all of the patients, 3 had fistula, 5 had wound infection and 6 had necrosis. Conclusion: CBS is an uncommon yet detrimental complication encountered in head and neck cancer patients, which is mostly treated by endovascular approach. However, surgical ligation is still a treatment option especially in patients with type III rupture. Since, there is a limited time for those patients preventive measures should be undertaken within 4 months following soft tissue exposure, necrosis and fistula.