Laryngeal framework surgery (LFS) can be divided into four groups: approximation laryngoplasty, expansion laryngoplasty, relaxation laryngoplasty, and tensioning laryngoplasty. Preoperative evaluation by the surgeon of a patient with vocal fold paralysis includes assessment of many factors and is done with subjective and objective methods. Laryngoplasty is a functional surgery, and it is important to have a patient who is able to cooperate during the procedure and be able to verbalize at the surgeon's request. Traditionally the procedure has been done using opioids, benzodiazepines, propofol. General anesthesia is considered by many of the surgeons unacceptable for laryngoplasty due to the need for the patient to verbalize during the procedure for better results. General anesthesia has some advantages, providing a quiet operative field with no laryngeal, cough or swallowing reflexes. The most common procedure reported done under general anesthesia is medialization thyroplasty, with few reports describing arytenoid adduction with or without thyroplasty.