The management of 120 laryngeal injury patients at a major trauma center over 23 years is presented in the form of two patient populations. The first population consists of 52 previously analyzed and reported laryngeal trauma patients who served as the basis for the subsequent refinement of treatment of a second population of 68 patients. Collectively, these patients form a series unique in that 1) it comprises the largest number of such injuries treated at one institution, 2) the management principles remained the same throughout the entire 23 years, and 3) the majority of the patients were managed by one physician. The experience gained from these patients is examined in the hope of resolving prevailing controversies about the treatment of the acutely injured larynx.