Depending o n whether its unilateral r bilateral vocal fold paralysis ,phonosurgery is designed to make the voice and airway better People with one paralyzed vocal cord often have a breathy, weak voice; in addition, they may aspirate - have food or liquid go into the lungs. Vocal Fold medialization surgery can help to close the voice box, provide a stronger, more natural voice, and help prevent aspiration. This can be accomplished by an injection of material into the vocal folds to help push them together. This injection is either performed in the office under topical anesthesia, or in the operating room. Another procedure requires a small incision over the Adam's apple and the placement of a small implant to push the paralyzed vocal fold toward the midline. Kashimas surgery designed for patients with bilateral vocal cord paralysis to provide an adequate airway and maintain a reasonable voice too is done with minimum post operative stay at the hospital .