Microlaryngoscopy procedures are often considered to be routine procedures at the straightforward end of the ENT operative spectrum. Complications associated with this surgery are thought to be infrequent and primarily related to the possibility of dental trauma and adverse voice outcomes. This retrospective review of the postoperative complications experienced by a cohort of 550 patients treated at the Tokyo Voice Centre over a period of two and a half years provides an illuminating insight into the nature and frequency of potential problems that may be encountered following microlaryngoscopy procedures. Overall, a surprisingly high 66% of patients reported a problem after surgery. Whilst the arguably inevitable and relatively trivial postoperative sore throat accounted for 40% of complaints, tongue-related complications (numbness, taste disorder, tongue pain and hypoglossal nerve palsy) were observed in 16.9% of all cases. Although all of these resolved with a median time to recovery of four days, recovery took longer than two weeks in 25% of cases of taste disorder and 21% of tongue numbness. The longest time to recovery was approximately four weeks. Tooth injury was noted to have occurred in 0.9% of all cases. The results of this study highlight the relatively common occurrence of transient tongue-related complications following microlaryngoscopy procedures. Whilst it is reassuring that all such issues were temporary, their frequency and occasionally prolonged nature do have important implications for the preoperative counselling and consenting of patients for whom microlaryngoscopy procedures are being considered.