Aims: Unilateral vocal fold paralysis (UVFP) impairs the capacity for lower airway protection, and phonation. This results in an increased risk of aspiration, and has a detrimental impact on quality of life. Medialisation of the paralysed cord allows the functional cord to adduct against it, restoring function, with medialisation thyroplasty being the procedure of choice to achieve this long term. We describe the historical developments which preceded and contributed to the medialisation thyroplasty of today. Methodology: A review of current and historical literature on the development of medialisation thyroplasty. Results: Vocal cord medialisation as a treatment for UVFP was first achieved by Brunings in 1911 by injecting paraffin into the vocal fold. Building upon this, Erwin Payr in 1915 demonstrated that a flap of thyroid cartilage could be collapsed inward to cause medial displacement of a paralysed vocal cord. Following this, there were several other attempts at manipulating the thyroid and arytenoid cartilages to achieve vocal cord medialisation. However, it would not be until 1974, when Isshiki et al developed the modern medialisation thyroplasty, that laryngeal framework surgery gained traction as a long term treatment for UVFP. Isshiki’s breakthrough technique utilised silastic implants and since then, the choice of implant has expanded to include hydroxylapatite, and Gore-Tex. Furthermore, medialisation thyroplasty has been combined with other laryngeal framework surgeries such as arytenoid adduction or adduction arytenopexy, and cricoid subluxation to deliver improved outcomes in phonation. Conclusion: Medialisation thyroplasty has evolved over time, building on pre-existing methods, and embracing advances in biotechnology. With new discoveries, the technique will continue to develop and deliver improved patient outcomes.