This chapter discusses open partial laryngeal procedures, where conus elasticus can act as an extralaryngeal pathway or pathway to the subglottis for larger tumors. The thyrohyoid ligament acts as a barrier to extralaryngeal spread of tumor. The paraglottic space can serve as a conduit for occult tumor spread between the supraglottis, glottis, and subglottis. Loss of the normal crepitus palpated upon moving the larynx back and forth may indicate extension of the tumor into the postcriocoid area. A direct laryngoscopy or a suspension microlaryngoscopy is also performed to map the tumor more accurately and assess fixation of the arytenoids. Arytenoid fixation indicates involvement of the cricoarytenoid joint with tumor, and may preclude conservation laryngeal surgery. Radiation therapy portals for the treatment of larynx cancer are primarily determined by the initial stage at the time of diagnosis.