Management of unilateral vocal fold paralysis continues to generate controversy. Various techniques, but essentially teflon injection and thyroplasty I have been widely used for medialization. Assessment procedures largely differ from author to author: a few authors report objective superiority of thyroplasty (small series). In our own material (19 teflon injections and 9 thyroplasties), when considering objective functional outcomes and patient satisfaction, we cannot demonstrate a statistically significant superiority of one of the techniques, both of them giving very satisfactory results. When considering the literature, the main problem with teflon is delayed (up to 25 years) occurence of granulomas, which is reported as not unfrequent and to some extent unpredictible. Management of teflon granulomas is difficult. Most major complications of thyroplasty (airway obstruction/prosthesis extrusion) occur quite early after surgery and can better be controlled.