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Achieving optimal voice restoration has long been the goal in total laryngectomy patients. Significantly, the achievement of a good voice has a great impact on the quality of life in this patient population. Numerous surgical and non-surgical options are available. Foremost of these is a tracheoesophageal puncture with use of a voice prosthesis. Creation of the tracheoesophageal puncture is a simple procedure which can be performed using a variety of techniques. It can also be done under general anesthesia or in the office setting. Surgical evaluation and ongoing care of the voice prosthesis is carried out in conjunction with the speech language pathologist. Most patients do well, with a variety of solutions being available for uncommon issues which may occur. In the majority of patients, alaryngeal speech is readily achievable. The head and neck surgeon should be well-versed in the techniques available. [ABSTRACT FROM AUTHOR]