Options for surgical treatment of vocal cord paralysis include vocal cord injection, medialization thyroplasty, and<unk> . Each of these techniques results in medialization of the paralyzed vocal cord. However,<unk>  is preferred in cases where there is a large posterior glottal gap or vertical misalignment between the vocal folds.<unk>  is often performed at the same time as a medialization thyroplasty. Animal model studies suggest that combining the two procedures produces better outcomes than when performing either alone. Posterior glottal gap The paralyzed vocal cord may rest close to or far from the midline. An extremely laterally positioned vocal cord can result in a large posterior glottal gap - an opening between the two vocal cords even when the functioning vocal cord is fully medialized. Vocal cord injection is ineffective for closing a large glottal gap.<unk>  is more effective than medialization thyroplasty for closing a posterior gap. It has been suggested that this is because<unk>  directly rotates the<unk>  cartilage and thus more actively medializes the posterior aspect of the vocal cord. Vertical glottal gap The paralyzed vocal cord may rest on a different plane than the opposite vocal cord. This results in a vertical gap between the two vocal cords that cannot be resolved using vocal cord injection or medialization thryoplasty. The suture placed in the<unk>  procedure mimics the action of the lateral cricoarytenoid muscle and pulls the vocal process of the<unk>  cartilage medially and inferiorly. Thus<unk>  can correct the vertical position of an elevated vocal cord.
Arytenoid adduction
Tongue thrust
Sinus lift
Cramp
Adams clasp
Arm recoil
Pressure of speech
Forehead lift