The acute care of 139 consecutive patients with external laryngeal trauma over a 27-year period is reported. This article represents an effort to periodically reevaluate our care of this relatively infrequent injury and to share our changes and refinements in treatment. This series provides the means to test and establish basic principles in the acute care of external laryngeal trauma because (1) the number of years encompassed by the article, (2) most patients were managed by one physician, (3) the relative consistency of management principles throughout the series, and (4) the delivery of trauma care in Dallas County, Texas, reflects a broad sampling of this injury within the geographic area.