Sixty-eight consecutive patients with infiltrating squamous cell carcinoma of the supraglottic larynx were referred to the senior author (R.K.D.) from January 1987 through December 1999. Forty-six patients (clinically staged T2) were selected to undergo endoscopic carbon dioxide laser supraglottic laryngectomy. Thirty-eight of these patients underwent planned postoperative irradiation. The other 8 patients were treated by surgery only, either because they had previously undergone irradiation or because they had refused postoperative irradiation. Eighteen cases (39%) were restaged from T2 to T3 on the basis of preepiglottic space invasion demonstrated on final pathology review. Primary site control was maintained in 97% of the combined-therapy patients and in all of the surgery-only patients without any salvage procedures. Regional control was attained in 96% of NO patients treated with irradiation alone, and 91% of N+ patients treated with modified radical neck dissection and postoperative irradiation. The combined-therapy group had only a 3% gastrostomy dependency rate, no tracheotomy dependency, a 5% aspiration pneumonia rate, and an average onset of independent swallowing at less than 2 weeks.