This surgical procedure introduces a shim between the inner wall of the larynx and the soft tissue supporting the vocal fold. As a result, the paralyzed vocal fold is supported in a position closer to the midline of the glottis, and retains its ability to vibrate and phonate efficiently.In addition to medialization thyroplasty, arytenoid adduction can be performed to improve phonation results. This medical procedure consists of pulling the vocal processes of the arytenoid medially while monitoring the voicing quality being produced by the patient. When the best phonation appears to be achieved, the vocal processes are then maintained in place by a thread.A further surgical intervention used to mitigate vocal fold paresis is laryngeal reinnervation. This procedure restores nerve supply to the larynx and can be accomplished according to different techniques. Depending on the specific condition (i.e. bilateral versus unilateral vocal fold paralysis), these techniques include reconnecting parts of the RLN, supplying the laryngeal muscles with a donor nerve like the ansa cervicalis, or connecting the RLN to a donor nerve. Post-surgical outcomes
In many cases, the surgical treatment options described above (temporary injection medialization, medialization thyroplasty, arytenoid adduction, and laryngeal reinnervation) have led to favourable outcomes as measured perceptually, acoustically, by laryngoscope, or via quality of life measures. However, none of these surgical interventions has been shown to be significantly better than the others. Voice therapy after surgery
It is generally recommended that voice therapy start 1 to 2 months after surgery, when swelling has subsided.
Radiation as a treatment for malignant head and neck tumors can reduce the number of blood vessels in the treatment area and lead to scarring. In some cases, this can paralyze the vagus nerve, of which the RLNs are branches. Tumors of the vagus nerve, called vagal neurilemmomas, can also paralyze the vocal folds. Trauma
VF paresis can result from trauma to one of more laryngeal nerves during intubation, surgery (e.g. thyroidectomy, spine surgery, carotid endartectomy, vagal nerve stimulator implantation), injection of botulinum neurotoxin, or penetrating neck trauma. Thyroid disease
Causes of VF paresis also include diseases of the thyroid gland, such as hypothyroidism, goiter, and thyroiditis. Systemic neurologic diseases
Several neurological diseases can cause VF paresis including:

Myasthenia Gravis (MG), a rare neuromuscular autoimmune disease. MGs dominant characteristic is muscles weakness including facial, jaw, pharyngeal and laryngeal muscles. Charcot-Marie-Tooth (CMT), a neurological heredity disease that affects both motor and sensory functions. CMT affects the nerve cells and interrupts the transmission of nerve impulses as it concerns the axons and the myelination of the nerve cells. Multiple Sclerosis (MS), which is an autoimmune disease that damages the myelin sheet surrounding the axons of the cranial nerves and the spinal nerves. There are several types of MS depending on the course of the disease. Spinocerebellar Degeneration, a term that refers to a rare yet diverse chronic disease that affects the brain and the spinal cord.