Laryngology vocal-fold paralysis Flashcards
The motor neurons of the recurrent laryngeal
nerve originate in what brainstem nucleus?
Nucleus ambiguous
How can neuronal injuries be classified?
Sunderland and Seddon injury table with neurosensory impairment and recovery potential
What accounts for the small amount of continued vocal fold adduction that may exist after transection of the ipsilateral recurrent laryngeal nerve?
Bilateral innervation of the interarytenoid muscle
What is the most common cause of unilateral true
vocal-fold paralysis
Surgical iatrogenic injury
What is the most common malignant cause of
unilateral true vocal-fold paralysis?
Lung carcinoma
Imaging of what region(s) should be obtained to
evaluate unilateral true vocal-fold immobility of
unknown cause?
Skull base to the upper chest to examine the full course of
the recurrent laryngeal nerve. CT or MRI is most commonly
used.
What is the most common swallowing problem associated with unilateral true vocal-fold immobility?
Aspiration of liquids
Unilateral true vocal-fold immobility may cause
dyspnea by what mechanism?
Incomplete glottic closure leading to air escape during
speech
What medications are known to have neurotoxic
effects that can lead to true vocal-fold paralysis?
Vinca alkaloids (vincristine, vinblastine) and cisplatinum
After a high vagal nerve injury, will the palate elevate toward or away from the injured side?
The palate will elevate away from the injured side.
What mucosal wave finding on videostrobosopy is
associated with unilateral vocal-fold paralysis?
Increased amplitude on the paralyzed side
A patient is evaluated for hoarseness and aspiration after suffering a known stroke involving the posterior inferior cerebellar artery. What is likely to
be seen on flexible laryngoscopy?
Paralysis of the ipsilateral true vocal fold Wallenberg syndrome, or lateral medullary syndrome, results in hoarseness secondary to true vocal-fold paralysis,
dysphagia, loss of pain and temperature sensation on the
ipsilateral face and contralateral body, and ipsilateral Horner syndrome.
What is the role of laryngeal electromyography
(EMG) in management of vocal-fold immobility?
EMG can differentiate paralysis from fixation and may
provide prognostic information regarding the potential for
recovery of mobility.
What is the primary goal of surgical intervention
for bilateral true vocal-fold paralysis?
Improving the airway while preserving voice and swallowing
What options, other than tracheotomy, exist for
management of airway compromise secondary to
bilateral true vocal-fold paralysis in the early post injury period?
● Endotracheal intubation
● Suture lateralization
● Botox injection
