A 68-year-old male presented to our emergency department with progressive dyspnea on exertion and hoarseness. Tracing his past history, he had received Co-60 radiotherapy for laryngeal cancer 20 years ago. On physical examination, there was dark desquamation over his neck and discharging wound over the anterior thyroid cartilage region ( Figure 1) with stridor breathing sound. Flexible fiberoptic laryngoscope revealed poor movement of bilateral vocal folds with narrowed glottic airway (Figure 2). Computed tomography (CT) demonstrated fragmentation of the thyroid cartilage with gas bubble around it (Figure 3). The diagnosis was delayed radionecrosis of the larynx. After admission, the patient received tracheostomy. No recurrent laryngeal cancer was found. The exertional dyspnea improved after the surgery and he was discharged under stable condition.Radiation therapies have been the organ preservation treatment for early-stage cancer of larynx for over 20 years. However, radiotherapy could induce several complications such as laryngeal edema, skin damage, and even cartilage necrosis. 1 The arytenoid cartilages are involved most frequently that lead to incomplete abduction or adduction of vocal folds. 2 Therefore, the patients who had laryngeal radionecrosis would present the symptoms with dysphagia, hoarseness, and airway obstruction. Most of laryngeal radionecrosis present with these symptoms within 1 year of radiotherapy; however, delayed presentations have been reported up to 50 years after treatment. 3 The diagnosis of radiation necrosis is made on clinical presentation and CT is an useful diagnostic tool, which demonstrate the destruction of cartilage. The treatment depends on the