This study included 20 cases of cancer larynx that were thought to be unfit for organ preservation surgery (OPS) by surgeons highly skilled in performing such procedures and underwent total laryngectomy as an alternative procedure. Preoperatively, the vocal fold, arytenoid & cricoarytenoid joint (CAJ) of each case were examined clinically and radiologically. The total laryngectomy specimens were subjected to whole organ sectioning and the glottic area of each case was examined histopathologicaly to detect tumor invasion of thyroarytenoid muscle (TAM) and cricoarytenoid joint (CAJ). This study showed that the causes of vocal fold fixation, in order frequency, were: Deep Thyroarytenoid muscle (TAM) invasion, CAJ invasion, weight effect and invasion of arytenoid cartilage. The results of the study show that 45 % of the cases would have been good candidates for organ preservation surgery (OPS). During preoperative assessment of patients to select candidates for organ reservation surgery (OPS) 3 different types of arytenoid fixation need to be differentiated: Primary arytenoid fixation, secondary arytenoid fixation and false arytenoid fixation. In light of results of this study we present a specific check list "traffic light check list" with easy to use color codes that we believe can help us to better choose candidates for OPS and decrease the number of unnecessary total laryngectomies.