Two years of experience with the video microlaryngoscope has identified the need for ancillary instrumentation to take full advantage of the system's potential. The authors developed the following additions to video microlaryngoscopy: 1) a hinged mirror that may be articulated from its pistol grip handle; 2) a 4-mm 30 degrees or 70 degrees angled telescope for examination of subglottic areas not accessible by mirror examination; and 3) angulated laryngeal instrumentation that permits operation on previously obscured anterior anatomy. The authors also find that the video microlaryngoscope's distal view eliminates interference with visualization caused by the syringe during vocal cord injection.