In 1991, Mikaelian et al were the first to report the use of autologous fat to treat glottic incompetence in URLNP.
Autologous fat has been routinely employed with success in treating aspiration due to URLNP.
Today reinnervation is essentially indicated in conjunction with other techniques for treating URLNP as a means of decreasing vocal fold atrophy.
The past two decades have seen the advent of laryngeal surgery for URLNP and a more widespread interest in objective acoustic and aerodynamic voice evaluation.
Summary of surgical techniques  Thyroplasty Teflon Autologaus fat Operating time 45 to 90 min 30 min 15 to 30 min Operating ease Easy +++ Very ++++ Very easy ++++ Reversibility Variable No Yes Anatomic changes Yes ++ Yes ++++ Little Complications ++ ++++ Rare Indications Definitive URLNP Definitive URLNP Any URLNP Cost Variable-moderate Low Low Results Immediate Immediate Immediate Excellent Variable voice Excellent Permanent or quality resorption reversible Permanent Nerve anastomosis Operating time 2 hr Operating ease Unpredictable Reversibility Yes Anatomic changes No Complications ++ Indications Early URLNP (use with another technique) Cost High (operating time) Results 2- to 6-month delay Variable vocal effect
Hoffman and McCulloch have described two types of glottic incompetence during phonation in URLNP.
Voicing is sometimes of such poor quality in URLNP that detection of the F0, and thus stroboscopy, is impossible.
Vibrations are asymmetric in URLNP due to the asymmetry in mass and muscle tone of the two VC.
This phenomenon can be seen immediately after the onset of URLNP or it can appear secondarily.
It is not clear if the supraglottic hyperactivity observed in URLNP is active or passive.
51] Turck in 1860 was the first to describe and publish a laryngoscopic description of URLNP.
Aspiration due to recurrent laryngeal nerve paralysis occurs generally during the pharyngeal phase due to insufficient laryngeal occlusion, but abnormalities in upper esophageal sphincter tone and relaxation have been documented in URLNP