We would like to compare the effectiveness of image-guided (IGRT) and intensity-modulated (IMRT) radiotherapy to spare the larynx in head and neck cancer patients. A retrospective review of 48 patients undergoing radiation for non-laryngeal and non-hypopharyngeal head and neck cancers. Mean laryngeal and hypopharyngeal dose was compared between 11 patients treated with IMRT and 37 patients treated with IGRT. Mean laryngeal dose was, respectively, 41.2 Gy and 22.8 Gy for the IMRT and IGRT technique (p<0.001). The radiation dose to the middle and inferior pharyngeal muscles was also significantly reduced with the IGRT technique. Mean pharyngeal dose was, respectively, 52 Gy and 26 Gy for the IMRT and IGRT technique (p=0.0001). Laryngeal sparing IGRT technique for head and neck cancer minimizes radiotherapy dose to the larynx and pharynx without sacrificing target coverage, even in the presence of neck lymph nodes.