<jats:sec><jats:title>Objectives:</jats:title><jats:p> We evaluated the functional and oncological outcomes of transoral laser microsurgery (TLM) in patients with previously untreated supraglottic carcinoma compared with the outcomes in salvage cases after radiation-based treatment. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> We conducted a retrospective case-control study at a single academic tertiary care institution. The functional outcomes were stratified by prior irradiation and were assessed at baseline, less than 1 week after operation, and at last follow-up. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> Five patients underwent TLM for previously untreated disease, and 5 previously irradiated patients underwent salvage TLM for local failure. No patient required tracheostomy. There was no local recurrence after TLM as primary therapy, and none of those patients required radiotherapy. One salvage patient developed local recurrence. The duration of feeding tube dependence (p = 0.049) and the rates of chronic aspiration (more than 1 month after operation; p = 0.048) were significantly higher in the salvage TLM cases than in the previously untreated cases. The median scores on the PSS-HN Understandability of Speech were 75 (“usually understandable”) in the salvage group and 100 (“always understandable”) in the previously untreated group. </jats:p></jats:sec><jats:sec><jats:title>Conclusions:</jats:title><jats:p> Both local control and function were better in the previously untreated patients than in the salvage patients. Our findings provide support for the use of TLM as a primary treatment modality for selected supraglottic carcinomas, but also suggest a potential for functional recovery in both previously untreated and salvage cases. </jats:p></jats:sec>