A subtotal laryngectomy may meet the requirements of adequate tumor resection in many patients who normally would undergo total laryngectomy. The uninvolved column of innervated endolarynx sacrificed at total laryngectomy to separate the airway and the food way can be preserved to valve a speaking shunt. Such a shunt remains patent and sphincteric without the use of a prosthesis an offers consistent advantages over "post-total" laryngectomy reconstructions. This report describes the principles of subtotal laryngectomy applied in 16 patients with laryngeal or pharyngeal carcinoma. The technique ensures entry into the larynx through tumor-free soft tissues and keeps the tumor margins under direct vision thereafter. During follow-up ranging from 6 months to 6 years, fistula speech has been retained and no local tumor has recurred.
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