Objective: To improve the perioperative management of patients with tracheal diverticulum undergoing neck surgery. Methods: A retrospective analysis was conducted on CT images of patients with head and neck tumors who underwent neck surgery from January 2017 to December 2022. The location, number, and size (maximum axial diameter) of all detected diverticula were recorded. Special events reported in the literature during head and neck tumor surgery were compiled. Results: A total of 1198 patients were included, with an incidence of tracheal diverticulum of 5.9% (70 cases). The median diameter of tracheal diverticulum was 8.22 mm (interquartile range [IQR], 5.23-11.11 mm). All tracheal diverticula were located on the right side of the trachea, with 95.7% (67 cases) at the T1-T2 vertebral level. And we report a case of pneumomediastinum and smooth recovery after conservative treatment. Literature revealed 2 cases of pneumothorax due to diverticulum rupture, 1 case of inability to establish mechanical ventilation, 1 case of difficulty distinguishing tracheal diverticulum from lymph nodes during surgery, and 1 case of recurrent upper respiratory tract infections. Conclusion: Tracheal diverticulum is not rare and should be carefully assessed on CT images before neck surgery. Meticulous surgical procedures, gentle intubation, and cautious lymph node dissection during surgery can prevent complications.