At the 1991 meeting of the Eastern Section of the Triological Society in Philadelphia, Pa, Yosef P. Krespi, MD, Daniel B. Kuriloff, MD, and Arnold Komisar, MD, Columbia Presbyterian Medical Center, New York, NY, presented their experience in the use of the midline approach for surgery of the larynx, pharynx, and trachea. Krespi reiterated that the goal in neck skin incision placement is to obtain adequate exposure of the surgical field without jeopardizing the cutaneous blood supply and increasing the potential for flap necrosis, carotid artery exposure, and formation of a pharyngocutaneous fistula. Those principles are especially important in elderly patients receiving radiation therapy. The midline neck incision does not cross the vertically oriented cutaneous blood supply of the platysma-cutaneous flaps. In the majority of individuals, the platysma does not cross the midline; therefore, the midline neck incision was found anatomically more suitable. The authors demonstrated their technique by means