In Buffalo's first playoff game since losing the Super Bowl two seasons ago, the Bills handled Miami easily. Although Dolphins quarterback Dan Marino completed 33 out of 64 passes for 422 yards, the Bills jumped to a 27–0 lead going into the fourth quarter, and rushed for an NFL playoff record 341 yards. It would be the final game of Don Shula's coaching career with the Dolphins. As of 2013, this was the last time that the Bills won a playoff game.
Running back Bam Morris scored two touchdowns in the fourth quarter as the Steelers stopped the Bills from coming back. Pittsburgh jumped to a 20–0 lead by the second quarter with running back John L. Williams's 1-yard touchdown, quarterback Neil O'Donnell's 10-yard touchdown pass to wide receiver Ernie Mills, and two field goals by Norm Johnson. However, Buffalo running back Thurman Thomas scored a 1-yard touchdown run with 45 seconds left in the first half. But Johnson made a 34-yard field goal with eight seconds left to give the Steelers a 23–7 halftime lead. In the third quarter, Johnson added a 39-yard field goal before Bills tight end Tony Cline caught a 2-yard touchdown reception. With 11:23 left in the game, Thomas scored on a 9-yard touchdown reception to cut the lead, 26–21. But Pittsburgh then marched 76 yards to score on Morris' 13-yard touchdown run. Linebacker Levon Kirkland then intercepted a pass to set up Morris' 2-yard score with 1:58 remaining to clinch the victory. Bruce Smith was inactive for the game because he had a 106-degree fever; Smith wanted to play but the Bills' medical staff said no.