OBJECTIVES: An analysis of thyroplasty with Montgomery implant under local anesthesia for unilateral laryngeal nerve paralysis. PATIENTS AND METHOD: An inception cohort of 21 patients was operated on with a minimum follow-up of 9 months. All patients had severe dysphonia and breathlessness. Seven patients had aspiration with a non efficient cough. RESULTS: The only adverse side effect was a subcutaneous cervical hematoma in one patient. Aspiration disappeared immediately after completion of the thyroplasty. Immediate improvement of speech, cough, and breathlessness was achieved in all patients. Over time, speech and voice remained stable in all patients. Recurrence of aspiration was not encountered. CONCLUSION: Such data supported the notion that the thyroplasty with Montgomery implant under local anesthesia is an extremely valuable option in patients with unilateral laryngeal nerve paralysis.