Objectives: The primary objective of this study is to evaluate the effectiveness and safety of injection laryngoplasty using a temporary injectable agent in the acute-care setting for patients with unilateral vocal cord paralysis following thoracic surgical procedures. Study Design: Retrospective consecutive case series in an academic institution. Methods: Inclusion criteria included patients acutely treated with injection laryngoplasty from January 1, 2006 to March 31, 2010 for a unilateral vocal cord paralysis that occurred after a thoracic surgical procedure (n=20). All patients were injected with Radiesse® VoiceGel using microlaryngoscopy technique. Results: The mean time to vocal cord injection from the time of thoracic surgery was 4.5 days. There was one operativerelated complication of intraoperative bile reflux that caused a pneumonitis. None of the patients developed a postinjection aspiration pneumonia. Ninety percent (18/20) of patients were recommended for strict nothing by mouth (NPO) prior to injection. Of these, 94 percent (17/18) were allowed an oral diet following injection, while 67 percent (12/18) tolerated a regular diet. Patients had a median follow-up of 127 days. None of the patients required subsequent procedures for aspiration or dysphagia, while 25 percent (5/20) of the patients required further surgical intervention after discharge for persistent dysphonia. Patients with a known nerve transection had a higher rate of dysphonia requiring further surgical procedures than those who did not have a known nerve transection. Conclusions: Acute treatment of thoracic surgeryrelated unilateral vocal cord paralysis with injection laryngoplasty appears safe, effective at preventing postoperative aspiration pneumonia, and improves swallowing function to allow resumption of an oral diet. For most patients, a single injection laryngoplasty is the only required treatment.