Transcutaneous Teflon augmentation of the vocal cord was performed 21 times in 19 patients with unilateral vocal cord paralysis. The larynx was visualized using flexible fiberoptic video-endoscopy and, after local anesthesia to the skin over the cricothyroid membrane, an 18-gauge 2-inch needle was introduced through the cricothyroid membrane. Under fiberoptic visualization, the needle was inserted into the paralyzed vocal cord through its undersurface. Teflon was injected with a syringe to produce medialization of the vocal cord. The position of the vocal cord and voice quality were monitored throughout the procedure. No complications were encountered. All patients experienced a reduction in breathiness of voice that was rated as a significant improvement by the patient and surgeon. Two patients required reinjection of Teflon for optimal improvement.