Bilateral midline vocal cord paralysis is usually a consequence of bilateral injury of the recurrent laryngeal nerve. Its most frequent etiology is the surgical section during thyroid surgery, although it may occur in other cervical or chest surgery. Although the vocal cord position at the midline offers good voice, the patient usually develop dyspneia at some degree. Several treatments were proposed, trying to establish a good laryngeal airway, but all resulted in a worse voice quality. The ideal treatment should offer good airway with minimal voice alteration. Many surgical techniques were proposed to increase the posterior laryngeal space (Woodman and Pennington procedure, cordotomy, medial arytenoid cartilage resection, arytenoidectomy, etc) or to promote the laryngeal reinnervation by neuromuscular graft. Rontal proposed the detachment of the adductor laryngeal muscles from the arytenoid cartilage (tenotomy). This surgery has been our choice for bilateral vocal cord paralysis for the last 1,5 years. It promotes the lateral rotation of the arytenoid and vocal cord bowing and can be performed in both sides, if necessary. Thus, there is increase of the airway and good voice preservation. We present the technique and discuss our surgical experience and results.