Radiotherapy plays an important role in the treatment of head and neck cancer. Radiation therapy to the head and neck cancer can cause an uncommon long term swallowing and breathing difficulties by causing stenosis at the pharynx, larynx and oesophagus. The dysphagia or breathing difficulties by radiation therapy may occur be mechanical, structural and neurological deficits. It hurts the quality of life among cancer survivors. This acquired pharyngeal stenosis after radiotherapy may threaten to live by compromising the airway. Radiation-induced pharyngeal stenosis may occur in cases with head and neck cancer which cause significant morbidity and mortality. This article reviews details of radiation-induced pharyngeal or upper aerodigestive stenosis with manifestations of dysphagia and compromised airway including its epidemiology, pathophysiology, clinical presentations, investigations and possible treatment options. The pathogenesis for dysphagia and stridor due to pharyngeal and oesophagal stenosis following radiotherapy is unclear. Severe mucositis in the pharynx might be the predisposing factor for causing fibrosis and leads to stenosis. The upper aerodigestive tract stenosis following radiotherapy is an unusual complication which can be treated with dilation or excision with scar tissue. Although there is no specific or gold standard treatment option found for this stenosis, many supportive, restorative and palliative treatments are available under various clinical conditions.