Incomplete vocal fold adduction during phonation causes patients to complain of difficulty in phonation, especially when they are competing with back-ground noise. Patients with unilateral vocal fold paralysis typically complain of breathy dysphonia, vocal fatigue, and aspiration of liquids. The treatment of unilateral vocal cord paralysis has a long history, marked by technical innovations and improvements. These methods typically use endoscopic injection or implants to augment the volume of the vocal fold. In medialization thyroplasty, the position of the vocal cord is medialized by an external approach in which a permanent implant is placed through a thyroid cartilage window intraoperatively, often with conscious sedation and intra-operative voice analysis. Medialization thyroplasty using various implants, commonly expanded polytetrafluoroethylene (E-PTFE) or Silastic, is seemed the gold standard treatment for large glottic gaps and is the mainstay surgical intervention for unilateral vocal cord palsy. Medialization thyroplasty is a widely accepted surgical procedure for improving insufficient glottal closure in patients with unilateral recurrent laryngeal nerve paralysis.