## 1 Introduction  
The vocal folds are a pair of highly specialized tissues housed in the larynx, which when adducted into glottal controlled airflow, vibrate to produce voice. In humans, the vocal folds consist of five distinct layers; luminal stratified squamous epithelia, three lamina propria layers, and a basal ligament (vocalis muscle), which are broadly segmented into a cover and body as previously described [1]. Disordered vocal folds lead to many impairments, including poor voice quality, swallowing dysfunction, breathlessness, and aspiration [2]. Unilateral vocal fold paralysis (UVFP) is a voice disorder caused by injury of the recurrent laryngeal nerve or vagus nerve innervating the larynx [3], resulting in impaired adduction, one-sided vocal fold immobility, and a widened glottal gap. UVFP has an iarogenic origin in around half of all cases [4], most frequently as a result of thyroidectomy or anterior cervical disk spinal fusion, but may also present idiophatically [5]. The symptomatic burden of UVFP on patients is significant with 53-100% of identified cases experiencing dysphonia [6, 7, 8], 60-75% dyspnea [9, 10], and approximately 60% dysphagia [6], resulting in an increased risk of aspiration [11]. Surgical intervention is necessary for more than half of patients diagnosed with UVFP, with a primary goal of medializing the affected vocal fold to correct the glottal insufficiency [10]. There are two commonly used techniques for medialization laryngoplasty. Injection laryngoplasty, a technique for which the vocal folds are medialized using an autologous or biologically inert substance that is injected directly into the thyroarytenoid muscle, is used to improve short-term voice outcomes (typically weeks to months depending on material and resorption rate) in patients who may experience spontaneous recovery or for whom more invasive surgery or general anesthesia is contraindicated [12; 13; 14; 15; 16; 17; 18]. Type I thyroplasty, a technique with which medialization is achieved by surgical insertion of a bio-tolerable implant (e.g., Silastic) or a stacked Gore-Tex ribbon through a window in the thyroid cartilage, provides longer duration results, but as with injection laryngoplasty, it is not without limitations, including: under/over medialization, size and shape variability when hand-carving implants, Gore-Tex compression over time, and inflammatory reactions. Inadequate medialization is reported relatively frequently, with 4.5-16% of type I thyroplasty procedures requiring surgical revision [19; 20; 21; 22; 23]. Previous efforts to surgically investigate type I thyroplasty are largely limited to studies in cadaver largynges assessing changes in biomechanics following implantation, or to histological analyses of larynges post-implantation; however, several in vivo and clinical studies evaluating phonatory measures have been described. In a canine model, [PERSON] et al. [24] simulated UVFP by cuffing the recurrent and superior laryngeal nerves and identified that artytenoid adduction + type I thyroplasty using the Hiroto method [25] increased vocal efficiency significantly more than augmentation alone, although the authors acknowledge that the longer posterior glottal chink in dogs vs. humans likely contributes to less optimal outcomes from implantation. Another study in a canine model identified significant impacts of both shape and medialization depth on fundamental frequency and aerodynamic power required for phonation and was also able to demonstrate reduced efficacy of type I thyroplasty in vagal paralysis vs. recurrent laryngeal nerve paralysis [26]. In a clinical population, type I thyroplasty in combination with cricothyroid suture approximation (also known as type IV thyroplasty) was demonstrated to improve video- stroboscopic, acoustic perceptual, and subjective dysphonia ratings in patients with unilateral superior laryngeal nerve weakness [27]. In a separate patient population with unilateral cricothyroid muscle paralysis, [PERSON] et al.