• Botulinum Toxin--- was applied in SD in 1984
• Using laryngeal EMG
• Direct vision with FOL
• Botox: is a potent neurotoxin which prevents the release of neurotransmitter acetylcholine at NM junction. By permanent binding of Botox to presynaptic nerve terminals.

   This blockage is irreversible and NM function     returns only when new terminals have sprouted and new NM junction are formed.

• Thyroplasty Type II (Isshiki) – still experimental
• Unilateral Recurrent laryngeal nerve section

    Long term 36% success

• Bilateral selective denervation of Thyroarytenoid muscle