Aim and objective: The development of an anterior commissure granuloma following medialization of the vocal fold with a silicone implant is a rare complication as silicone is a relatively inert material. However, when such granulomas do develop, they are often picked up late due to slow progression over years. Case description: Our article focuses on the clinical presentation, evaluation, and management of a patient with an anterior commissure granuloma and thyroid cartilage chondronecrosis who presented to us with a history of multiple medialization laryngoplasties in the past, following an immobile vocal fold which was after a parapharyngeal tumor excision. Conclusion: Though anterior commissure granulomas following medialization laryngoplasty are not frequently seen currently due to the use of implants that produce minimal foreign body reaction and sterile conditions, we believe that in our case the etiology of the granuloma formation with chondronecrosis of the thyroid cartilage may be due to the very large size of the revision implant with resultant extrusion with foreign body reaction leading to long-standing infection. Clinical significance: Any implant however inert, runs a small risk of infection with granuloma formation which is more likely with large implants and multiple surgeries causing devascularization of tissues. Close observation following thyroplasty with stroboscopy and imaging when needed may help pick up complications early, avoiding progression to chondronecrosis and possibly respiratory distress.