Traumatic atlantooccipital dislocation is usually fatal. Few case reports surviving this injury appeared in the literature. We report a rare case of a retropharyngeal hematoma and an atlantooccipital dislocation with survival. A 31-year-old male fell from a motorcycle and was thrown. His neurological examination showed mild weakness (gr III) and numbness of the arms. Enlargement of retropharyngeal space on the lateral cervical radiography helped to recognize the diagnosis. The BAI-BDI method proposed by Harris et al. were useful for diagnosis. Additional imaging, including CT and MRI, was helpful. He was diagnosed atolantooccipital dislocation, retropharyngeal hematoma, cervical subdural hematoma, traumatic subarachnoid hemorrhage, and mandibular fracture. He was orally intubated and the Philadelphia cervical collar was replaced. Additionally, occipitocervical fusion with internal fixation was performed. We emphasize that the presence of retropharyngeal hematoma leads us to perform airway interventions and to suspect the presence of the upper cervical spine injury including atlantooccipital dislocation.