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Objective The aim was to assess the voice outcomes of cold phonomicrosurgery for minimal-associated pathological lesions of the vocal folds. Materials and methods A total of 26 patients with either unilateral or bilateral minimal-associated pathological lesions of the vocal folds from the Otorhinolaryngology Department in Zagazig University Hospitals between 2013 and 2014 were enrolled in the case group. Cold phonomicrosurgeries were performed. The control group comprised of 20 matched normal individuals. Matching was based on sex, age, and socioeconomic rank. Results All patients had videoendoscopic laryngeal evaluations in the preoperative and postoperative periods (3 months after surgery), and the results showed the absence of the lesion in comparison with the preoperative findings in 22 (84.62%) patients. All patients had perceptual voice analysis in the preoperative and postoperative periods (3 months after surgery), with all P values below 0.05, indicating statistically significant difference among the cases after the operation. Conclusion Although voice therapy is the cornerstone in treating benign vocal fold lesions, phonosurgery has an important role in some lesions.