Hypopharyngeal stenosis after total laryngectomy is a relatively frequent complication. In our series we found that approximately 20% of total laryngectomies require treatment for hypopharyngeal stenosis. This presentation analyzed the factors that contribute to hypopharyngeal stenosis in a large series of patients treated at Emory University and affiliated hospitals. Analysis is presented on the effects of location of the cancer, extent of resection, radiation therapy, and methods of reconstruction. The highest incidence of hypopharyngeal stenosis was found in hypopharyngeal vs. endolaryngeal lesions. The surgical decision examined in this paper is whether a primary "tight closure" of the hypopharynx or a flap or graft reconstruction gives the best results with the lowest complication rate. The best treatment of hypopharyngeal stenosis is its prevention. This paper deals with the methods of identifying the surgical situation when one is most apt to have stenosis and suggest appropriate measures to prevent these complications.