Bilateral vocal fold immobility frequently results in severe glottic airway compromise requiring surgical intervention to manage the airway. Reconstruction of the larynx to establish an adequate airway should preserve functional voice and swallow. Traditional open and endoscopic cold instrument techniques resulted in excessive bleeding and/or associated morbidities. The introduction of the carbon dioxide laser limited bleeding and allowed for greater visualization, thereby becoming the preferred method of endoscopic cordotomy and partial arytenoidectomy for bilateral vocal fold immobility.