Download MBBS (Bachelor of Medicine and Bachelor of Surgery) 4th Year (Final Year) ENT Laryngeal paralysis Handwritten Notes
FUNCTIONS OF VOCAL CORD
? RESPIRATION
? SPEECH
? PREVENTION OF ASPIRATION AND GENERATION OF
COUGH
NERVE SUPPLY
MOTOR
SENSORY
? RECURRENT LARYNGEAL N.
SUPPLIES ALL MUSCLES EXCEPT
CRICOTHYROID
? ABOVE VOCAL CORD ? BELOW VOCAL
? CRICOTHYROID IS SUPPLIED BY INTERNAL
CORD
RECURRENT
EXTERNAL LARYNGEAL LARYNGEAL N LARYNGEAL N
SUPERIOR LARYNGEAL NERVE
? IT ARISE FROM INFERIOR GANGLION OF VAGUS NERVE
,DESCENDS BEHIND INTERNAL CAROTID ARTERY,AND AT THE
LEVEL OF GREATER CORNUA OF HYOID BONE DIVIDES IN TO
EXTERNAL AND INTERNAL LARYNGEAL NERVE
? THE EXTERNAL BRANCH SUPPLIES CRICOTHYROID MUSCLE
WHILE THE INTERNAL BRANCH PIERCE THYROHYOID
MEMBRANE AND PROVIDE THE SENSORY SUPPLY OF LARYNX
AND HYPOPHARYNX
RECURRENT LARYNGEAL NERVE
? RT.RECURRENT LARYNGEAL N ARISES FROM THE
VAGUS N AT THE LEVEL OF SUBCLAVIAN ARTERY HOOKS
ROUND IT AND ASCENDS BETWEEN THE ESOPHAGUS AND
TRACHEA
? LT.RECURRENT LARYNGEAL N ARISES IN THE
MEDIASTINUM AT THE LEVEL OF ARCH OF AORTA HOOKS
ROUND IT AND ASCENDS UPWARD IN TO THE NECK IN THE
TR ACHEO ESOPHAGEAL GROOVE
? LT.RECURRENT LARYNGEAL N HAS A LONG COURSE
HENCE MORE PRONE TO PARALYSIS AS COMPARED TO
RIGHT
CAUSES OF LARYNGEAL PARALYSIS
? SUPRANUCLEAR RARE
? NUCLEAR:NUCLEUS AMBIGUS IN THE MEDULLA
VASCULAR ,NEOPLASTIC, MOTOR NEURON DISEASE ,POLIO AND
SYRINGIOBULBIA
? THERE WILL BE ASSOCIATED PARALYSIS OF CN AND NEURAL
PATHWAYS
? HIGH VAGAL LESION ? INTRACRANIALLY ? JUGULAR FORAMEN ?
PARAPHARYNGEAL SPACE
? LOW VAGAL OR RECURRENT LARYNGEAL NERVE
? SYSTEMIC CAUSE :DIABETES ,SYPHILIS,DIPHTHERIA,TYPHOID
,STREPTOCOCCAL OR VIRAL INFECTION,LEAD POISONING
? IDIOPATHIC
.
THEORIES ON POSITION OF VOCAL CORD IN
VOCAL CORD PARALYSIS
? SEMON'S LAW :IN ALL PROGRESSIVE LESIONS , ABDUCTOR
FIBRES OF NERVE,WHICH ARE PHYLOGENETICALLY
NEWER,ARE MORE SUSCEPTIBLE AND FIRST TO BE
PARALYSED COMPARED TO ADDUCTORS
? WAGNER AND GROSSMAN HYPOTHESIS: COMPLETE
PARALYSIS OF RECURRENT LARYNGEAL NERVE VOCAL CORD
WILL BE PARAMEDIAN DUE TO INTACT CRICOTHYROID
(ADDUCTOR FUNCTION) WHEN SUPERIOR LARYNGEAL NERVE
ALSO PARALYSED ..CADAVERIC POSITION
VOCAL CORD POSITION
CLASSIFICATION OF LARYNGEAL
PARALYSIS
? LARYNGEAL PARALYSIS MAY BE UNILATERAL OR BILATERAL
AND MAY INVOLVE
1. RECURRENT LARYNGEAL N
2. SUPERIOR LARYNGEAL N
3. COMBINED OR COMPLETE
RECURRENT LARYNGEAL NERVE
? A. UNILATERAL PARALYSIS
IPSILATERAL PARALYSIS OF ALL INTRINSIC MUSCLES
EXCEPT THE CRICOTHYROID
VOCAL CORD THUS ASSUMES MEDIAN OR PARAMEDIAN
POSITION
IT DOES NOT MOVE LATERALLY ON DEEP INSPIRATION
CLINICAL FEATURES
? ASYMPTOMATIC
? VOICE CHANGE
? NO ASPIRATION OR AIRWAY OBSTRUCTION
VOICE IMPROVES DUE TO COMPENSATION BY
THE HEALTHY CORD WHICH CROSSES MIDLINE TO
MEET PARALYSED ONE.
B.BILATERAL (BILATERAL ABDUCTOR PARALYSIS(
? ETIOLOGY
NEURITIS OR SURGICAL TRAUMA ( THYROIDECTOMY(
? POSITION OF CORD
ALL THE INTRINSIC MUSCLES OF LARYNX ARE PARALYSED,THE VOCAL CORD
LIE IN MEDIAN OR PARAMEDIAN POSITION DUE TO UNOPPOSED ACTION OF
CRICOTHYROID MUSCLES.
? CLINICAL FEATURES:
1. DYSPNOEA ?AS BOTH CORDS LIE MEDIAN OR PARAMEDIAN .AIRWAY IS
INADEQUATE
2. STRIDOR
BECOMES WORSE ON EXERTION OR A/C LARYNGITIS
PARALYSIS OF SUPERIOR LARYNGEAL N
.1UNILATERAL (RARE
COMBINED(
CLINICAL FEATURES
? PARALYSIS OF CRICOTHYROID
? WEAK VOICE WITH DECREASE PITCH
MUSCLE AND IPSILATERAL
? ANAESTHESIA OF LARYNX ON ONE SIDE
ANAESTHESIA OF LARYNX
? ASPIRATION
ABOVE VOCAL CORD
? LARYNGEAL FINDINGS
? ETIOLOGY
? ASKEW POSITION OF GLOTTIS AS ANT
COMMISSURE IS ROTATED TO HEALTHY
1. THYROID SURGERY
SIDE
2. THYROID TUMOR
? SHORTENING OF CORD WITH LOSS OF
3. DIPHTHERIA
TENSION(WAVY(
? FLAPPING OF PARALYSED CORD
...CORD SAGS DOWN DURING
INSPIRATION AND BULGES UP DURING
EXPIRATION
.2BILATERAL
? UNCOMMON CONDITION
? BOTH CRICOID MUSCLES ARE PARALYSED WITH ANAESTHESIA OF
UPPER LARYNX
? ETIOLOGY
? SURGICAL OR ACCIDENTAL TRAUMA
? DIPHTHERIA
? PRESSURE BY CERVICAL NODES
? NEOPLASTIC DISORDERS
? CLINICAL FEATURES
? PARALYSIS AND BILATERAL ANAESTHESIA
? COUGH
? CHOKING FITS
? VOICE IS WEAK AND HUSKY
COMBINED (COMPLETE) PARA LYSIS
? RECURRENT LARYNGEAL AND SUPERIOR LARYNGEAL NERVE PARALYSIS
.1 UNILATERAL
? PARALYSIS OF ALL MUSCLES OF LARYNX ON ONE SIDE EXCEPT THE
INTERARYTENOID WHICH RECEIVE INNERVATION FROM OPPOSITE SIDE
AETIOLOGY
? THYROID SURGERY
? LESIONS OF NUCLEUS AMBIGUS OR MEDULLA,POST CRANIAL FOSSA,JUGULAR
FORAMEN,PARA PHARYNGEAL SPACE
CLINICAL FEATURES
? ALL MUSCLES OF LARYNX ON ONE SIDE IS PARALYSED( VOCAL CORD IN
CADAVERIC POSITION(
? GLOTTIC INCOMPETENCE (HEALTHY CORD IS UNABLE TO APPROXIMATE THE
PARALYSED CORD(
? HOARSENESS OF VOICE AND ASPIRATION OF LIQUID THROUGH GLOTTIS
.2BILATERAL
? BOTH RECURRENT LARYNGEAL N AND SUPERIOR LARYNGEAL
NERVE ON BOTH SIDES
? RARE CONDITION
? CORDS LIE IN CADAVERIC POSITION
? TOTAL ANAESTHESIA OF LARYNX
CLINICAL FEATURES
? APHONIA AS CORDS DON'T MEET AT ALL
? ASPIRATION..INCOMPLETE GLOTTIS AND LARYNX ANAESTHESIA
? INABILITY TO COUGH INABILITY TO MEET....:RETENTION OF
SECRETIONS IN CHEST
? BRONCHOPNEUMONIA ...REPEATED ASPIRATION AND RETENTION
OF SECRETION
CONGENITAL VOCAL CORD PALSY
? UNILATERAL (MORE COMMON(
? BIRTH TRAUMA
? CONGENITAL ANOMALY OF GREAT VESSEL OR HEART
? BILATERAL
? HYDROCEPHALUS OR ARNOLD -CHIARI MALFORMATION
? INTRACEREBRAL HEMORRHAGE DURING BIRTH
? MENINGOCELE OR CEREBRAL OR NUCLEUS AMBIGUS
AGENESIS
BILATERAL ABDUCTOR PARALYSIS AND RESPIRATORY
OBSTRUCTION NECESSITATING TRACHEOSTOMY
This post was last modified on 11 August 2021