Teflon injection for unilateral vocal cord paralysis frequently produces an improved yet breathy voice. Ansa hypoglossi-recurrent laryngeal nerve anastomosis has been performed in five patients. In the four patients discussed in this paper, excellent phonatory quality has been achieved. Electroacoustic analysis indicates that this technique may produce normal phonatory function in paralyzed larynges. There have been no serious side effects or complications in our first five patients. Denervation of the sternothyroid muscle, which results from sectioning its nerve in preparation for suture to the RLN, appears to further improve the voice by medially positioning the vocal cord. Gelfoam paste is injected at the time of nerve transfer to rehabilitate the voice during the 2 months required for nerve regeneration. For younger patients, or those with professional use of their voices, this technique offers superior speech results when compared with Teflon injection.