Two cases of laryngeal smooth muscle rumours are reported: one a benign leiomyoma, the other a malignant leiomyosarcoma. These tumours may present diagnostic difficulties and immunocytochemistry is helpful in distinguishing smooth muscle rumours from other connective tissue neoplasms and spindle cell squamous carcinoma. Primary treatment in both cases should be surgical resection with small (T-1, T-2) malignant tumours s suitable for partial laryngectomy. Postoperative radiotherapy may have a role in allowing a more limited surgical resection.