A 47-year-old man was referred for TEF. He underwent tracheostomy three months ago to maintain prolonged ventilator care. Computed tomography (CT) scan and fiberoptic examination showed bilateral vocal cord palsy with median fixation and about 2 inch sized long segmental tracheoesophageal fistula (TEF) tract along the necrotic cricoid and tracheal cartilages. Narrow field total laryngectomy was performed to remove devitalized cartilages and mucosa, and repair TEF. He discharged without complication except mild stenotic change of tracheal fenestration 19 days later.