A 25 years old woman was adrnitted to the department of neurosurgery for a right hemifacial spasm. She was undertaken microvascular decompression in the Fukushima lateral position. Following completion of operation, she began to complain of dyspnea, but the phonation was not changed. Mild weakness and paresthesia on left upper extremity was complained, too. Severe swelling on the left side of face and neck expending to left shoulder was noted simultaneously. Immediate computerized tomography was taken to reveal the cause of respiratory distress, which suggested that venous and/or lymphatic congestion on the left side of neck. As respiratory distress was getting more severe, emergent tracheostomy was taken. The cause of above symptoms was suspected to an extreme rotation and flexion of the head resulting in direct contact of mandibular body to clavicle. A month after operation, there was still remained mild paresthesia on left thumb and index finger.