Vocal fold paralysis is a prevalent manifestation of various disorders inclusive of the commonest conditions, such as, cardiothoracic surgeries, head and neck malignancies, whereas parathyroid cysts and cervical osteophytes are the rarest causes of this common presentation. A comprehensive systematic review of the literature was done with keyword “parathyroid cysts causing vocal fold palsy” using MEDLINE, PubMed, additionally following PRISMA 2009 guidelines. A 59-year-old male patient presented with hoarseness of voice with right-sided neck swelling for one year. Excision of swelling adherent to the carotid sheath was done. Postoperative histopathological and biochemical analysis of aspirated fluid was consistent with the parathyroid cyst. Patient is in regular follow-up, and there are no clinical signs of recurrence and there is normal functioning of the affected vocal cord. This report adds to the growing knowledge of rare parathyroid cysts with unusual presentations, along with an understanding of pathophysiology, clinical diagnosis, and recovery options for vocal fold palsy due to lesions in the parathyroid gland.