Total laryngectomy can be used to prevent aspiration pneumonia in patients with severe dysphagia, though caution is required with regard to the indications. In this paper, we describe 3 patients in whom severe dysphagia developed as a result of cerebrovascular disorders, and who repeatedly developed aspiration pneumonia. We managed them with total laryngectomy, and this has prevented aspiration pneumonia in all three. Oral feeding became possible in two of these patients, and home care became possible for one. This report includes a discussion based on the literature, and includes preoperative evaluation and indications for laryngectomy.