Abstract Direct exposure of the superior mediastinum is essential when resecting subglottic tumours of the larynx, neoplasms of the cervical trachea or cervical oesophagus. This facilitates low resection of the trachea and clearance of the paratracheal nodes. This may best be carried out by removal of most of the manubrium sterni and both sternoclavicular joints and this operation has been performed in 22 patients with minimal morbidity or long term disability.