Background and objective The peak incidence of laryngeal cancer is seen in individuals aged over 65 years, with very few patients under 50 years developing advanced laryngeal cancer necessitating laryngectomy. Apart from often delayed diagnosis, this younger cohort faces a unique set of challenges related to fertility preservation, lower recruitment to clinical trials, and significant psychological impact. In light of this, this case series aimed to examine the various characteristics of patients below the age of 50 years undergoing total laryngectomy. Methods We reviewed departmental records at the University College Hospital London, spanning a period of 10 years, to identify patients who underwent total laryngectomy under the age of 50 years. Results The group comprised a total of nine patients over the age of 10 years: five males and four females. Six (66.7%) patients were smokers, and two (22.2%) had human papillomavirus (HPV)-16-positive disease. These patients underwent a variety of operative techniques. The length of postoperative inpatient stay varied greatly, ranging from five to 44 days (mean: 23 days). Conclusion There appears to be a lower prevalence of classical risk factors in our younger cohort undergoing total laryngectomy, as well as a reduced incidence of HPV-16 and a higher proportion of females. We also bring to light the significant psychological impact that these younger patients face and highlight the key learning point that clinicians must be vigilant in investigating younger patients with suspicious symptoms, even in the absence of obvious risk factors. Although further research is needed, this series is unique in that currently there are no other papers outlining laryngectomies in a patient group aged below 50 years.