We experienced a case of unilateral vocal cord paralysis following tracheal extubation. The patient was a 60-year-old man undergoing subtotal gastrectomy. He had no laryngeal symptoms prior to operation and the trachea was intubated with a cuffed endotracheal tube. The surgical procedure lasted 6 hours and was uneventful. Three days later after operation, he began to complain of hoarseness and mild aspiration symptom. On endoscopic examination, left vocal cord paralysis was found. Fifteen weeks later the voice and left vocal cord function return to normal without specific management. In this case, we suggested that possible causes of unilateral vocal cord paralysis are compression of recurrent laryngeal nerve by overexpanded endotracheal cuff, laryngeal trauma during difficult intubation, stretching of the nerve as a result of traction on distant organ, decreased elasticity of trachea and surrounding tissues in the older age group and long operating time.