Acute airway obstruction in the adult can be caused by a rapidly enlarging laryngeal cyst that may present unusually as a midline neck mass. In this case report we present a different surgical technique for the removal of a large combined laryngocele via midline transcervical approach that did not require laryngofissure. This technique allowed simple and fast access, excellent exposure and complete removal of the lesion without resection of thyroid cartilage or associated morbidities.