Systematic preoperative assessment by the surgeon and speech pathologist reduces complications and increases the success rates of tracheoesophageal (TE) voice restoration by identifying unsuitable candidates for the procedure. Preselection criteria are based on the various medical, psychologic, structural, and physiologic factors that are contraindications to the procedure or are associated with failure of the TE method. Predictive testing as part of the preoperative evaluation for secondary voice restoration can identify patients with structural or physiologic abnormalities that will hinder the development of satisfactory TE speech. Early recognition and management of potential obstacles to TE voice production will shorten the recovery time to achieve functional communication,and allow more laryngectomees to benefit from the TE voice restoration method of alaryngeal communication.