<prompt> A chronic smoker with history of hoarseness of voice found to have fixation of vocal cords on examination. The most likely treatment he will require isLASERSubtotal laryngectomyStripping of the vocal cordRadiotherapy  <response>: Fixation of vocal cords on examination is T3 lesion.Total laryngectomy. The entire larynx including the hyoid bone, pre-epiglottic space, strap muscles and one or more rings of trachea are removed. Pharyngeal wallis repaired and lower tracheal stump sutured to the skin for breathing. Laryngectomy may be combined with block dissection for nodal metastasis.Total laryngectomy is indicated in the following conditions:i T3 lesions i.e. with cord fixedii All T4 lesionsiii Invasion of thyroid or cricoid cailageiv Bilateral arytenoid cailage involvementv Lesions of posterior commissurevi Failure after radiotherapy or conservation surgeryvii Transglottic cancers, i.e. tumours involving supraglottis and glottis acrossDhingra 6e pg: 310 