Laryngeal Reinnervation Versus Thyroplasty in Patients With Vocal Fold Weakness.

Inclusion Criteria: * UVFP due to unilateral recurrent laryngeal nerve paralysis of traumatic, iatrogenic or idiopathic origin of between 6 and 60 months duration. Or symptoms that have not sufficiently improved with speech therapy alone, as determined by the patient and agreed by a multidisciplinary clinical team, after 6 months and pending a surgical decision. * Age from 18 to 70 years old * Male or female * Able to provide informed consent * A significant voice disorder as measured by perceptual rating (Grade ≥2 GRBAS Scale) and Voice Handicap Index (VHI-10 score \>16) * Common laryngeal electromyography (EMG, neurophysiological) criteria (Koufman Grades 2-5) in either the thyroarytenoid (TA) or posterior cricoarytenoid (PCA) muscle on the paralysed side. Exclusion Criteria: * Impaired vocal fold mobility but a normal EMG (Koufman Grade I) * Severe lung disorders * Structural vocal fold lesions such as polyp * Previous laryngeal framework surgery * Cricoarytenoid joint fixation (CAJF) * Significant non-laryngeal speech abnormality (severe dysarthria determined by a panel of trained speech therapists) * Previous Level 2, 3 or 4 thyroid neck dissection * Previous ipsilateral surgical neck dissection * Previous radiotherapy to the head and neck * Laryngeal injection of a rapidly absorbable material in the last 6 months. * Previous laryngeal injection of a non-rapidly absorbable material (e.g. bioplastics, VOX) * Neuromuscular disease affecting the larynx or multiple crania…