PURPOSE: The purpose of this study was to determine normal CT appearance of the neck after total laryngectomy and to evaluate the role of CT in accessing recurrent neoplasm. MATERIALS AND METHODS: In 65 patients who had undergone total laryngectomy, CT findings relating to shape of the neopharynx and alterations of normal anatomic structures were retrospectively reviewed. Fifty-five patients had also undergone neck dissection, and 47 patients had had adjuvant radiation therapy. RESULTS: In 27 patients, a normal neopharynx with a round or ovoid structure connecting the base of the tongue with the cervical esophagus had even wall thickness and iso- or slight hyperdensity to muscle. Fourteen of 32 patients with recurrent neoplasm showed an ill-defined, peripherally enhancing hypodense mass. Twenty-three patients developed metastatic lymphadenopathy and five patients developed coincidental local recurrent mass and lymphadenopathy. Hypodense masses mimicking recurrence were found in six patients and two cases revealed granulation tissues in the oropharynx(n = 2) and abscesses(n = 2). Another four patients were considered to be cases of immediate postoperative fluid collection or lymphocele. CONCLUSION: Aknowledge of normal CT findings of the neck after total laryngectomy is useful in the evaluation of recurrent laryngeal carcinoma.