The laryngeal and hypopharyngeal smooth muscle tumors are very rare. One case of hypopharyngeal leiomyosarcoma and two cases of laryngeal smooth muscle tumors were reported: one angioleiomyoma, one leiomyosarcoma and one carcinoleiomyosarcoma. The patients usually present no characteristic symptoms in early stage and the clinical symptoms are similar to squamous cell carcinoma. It is difficult to make a correct diagnosis before operation. Treatment of first choice consists of primary radical resection including a large part of normal tissue. Early lymph node metastasis is rare. Precautary neck dissection is not indicated for subclinic cervical nodal disease. Radiotherapy may be taken as adjuvant or palliative measures.