Aim: To evaluate national trends in laryngectomy procedures in Australia from 2000–2018, focusing on demographic shifts, procedural subtypes, and the impact of evolving oncologic management. Methods: A retrospective analysis of Australian Institute of Health and Welfare (AIHW) data identified all laryngectomy procedures—total, hemi-, supraglottic, and laryngopharyngectomy—performed between 2000 and 2018. Annual volumes, population-adjusted rates, and demographic variables (age, sex) were extracted. Temporal trends were assessed using linear regression and Welch’s t-tests. Missing data were proportionally imputed, and mean age estimated by weighted mid-point. Results: A total of 4,729 laryngectomies were recorded nationally. Most patients were male (86.9%) with a mean age of 63.4 years. The proportion of male cases declined significantly (from 88.6% to 82.5%, R² = 0.49, p < 0.001), with a modest rise in mean age (from 62.9 to 63.8 years, p = 0.02). Total laryngectomy predominated (58.5%), followed by supraglottic (19.1%), laryngopharyngectomy (11.9%), and hemilaryngectomy (10.5%). While overall case numbers remained steady, population-adjusted rates fell from 9 to 5 per million (R² = 0.71, p < 0.0001). Subtype analysis showed significant per-capita declines in total (p < 0.0001) and hemi-laryngectomy (p = 0.02), whereas supraglottic procedures rose proportionally (p < 0.05). Conclusion: Per-capita laryngectomy rates in Australia have fallen substantially, reflecting the global shift toward organ-preservation therapies. Nonetheless, laryngectomy remains essential for advanced or radiation-resistant disease. These national data underscore the need to maintain centralised multidisciplinary services and preserve surgical and rehabilitative expertise amid changing oncologic treatment paradigms.