A technique of primary neoglottic reconstruction for surgical restoration of voice following total laryngectomy is described in detail. This technique has been performed on 30 patients at the University of Texas Medical Branch, and our results are reported. Twenty (67%) of these patients are speaking with their neoglottises after one year. Indications for neoglottic reconstruction are discussed, based on a review of the problems and complications which we have experienced. Relative contraindications to the procedure are extension of tumor beyond the anatomic boundaries of the larynx, patients with poor pulmonary reserve, or those with significant esophageal reflux incompetence. Radiotherapy is not a contraindication to neoglottic reconstruction. It does predispose the patient to increased morbidity with spontaneous closure of the neoglottis, as well as aspiration, occurring occasionally. Other problems which are discussed include aspiration, postoperative wound infection, and patient compliance with the procedure. Results to date have been very encouraging, meriting further investigation of this one-stage vocal rehabilitation.