Laryngotracheal stenosis remains a challenging condition to manage, with treatment options plagued by either high rates of recurrence or excessive morbidity. The authors describe two cases of adult laryngotracheal stenosis treated by a hyoid interposition composite graft. A two-step procedure is described in this study. The first patient had tracheal stenosis at rings 3-4 secondary to prolonged intubation, and the second had laryngeal stenosis due to lymphangiomatosis. In both cases an anterior split is performed through either the trachea or the larynx, and a mucosa lined ‘trough’ created. As a second stage procedure, the central portion of the hyoid bone is mobilised with thyrohyoid muscles on either side acting as pedicles, and reflected downwards into the trough. A covering tracheostomy is sited inferiorly and the patient is decannulated at a later date. The two patients had two- and ten-year follow-ups with satisfactory airway and swallow. Compared to primary laryngotracheal resection with end-to-end anastomosis, this procedure has the disadvantage of being a two-stage procedure. However, injury to the recurrent laryngeal nerves remains a notable risk in primary resection, and this technique may be a useful option depending on patient and surgeon preference.