Download MBBS (Bachelor of Medicine and Bachelor of Surgery) 4th Year (Final Year) ENT Laryngeal paralysis Handwritten Notes
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FUNCTIONS OF VOCAL CORD
? RESPIRATION
? SPEECH
? PREVENTION OF ASPIRATION AND GENERATION OF
COUGH
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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
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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
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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
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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
.
![](fff7055b-ea71-467a-9457-e5592f7abe67-10_1.jpg)
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
![](fff7055b-ea71-467a-9457-e5592f7abe67-11_1.jpg)
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VOCAL CORD POSITION
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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
![](fff7055b-ea71-467a-9457-e5592f7abe67-13_1.jpg)
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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
![](fff7055b-ea71-467a-9457-e5592f7abe67-14_1.jpg)
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.
![](fff7055b-ea71-467a-9457-e5592f7abe67-15_1.jpg)
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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
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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
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.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
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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
![](fff7055b-ea71-467a-9457-e5592f7abe67-22_1.jpg)
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.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
![](fff7055b-ea71-467a-9457-e5592f7abe67-24_1.jpg)
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