文档介绍：UNILATERAL VOCAL FOLD PARALYSIS
Naren Venkatesan, MD
Michael P. Underbrink, MD
The University of Texas Medical Branch
Department of Otolaryngology
Grand Rounds Presentation
February 25, 2011
档蒂仔城甥销锹瑶爵弹赘磷举仓梧位部轩菌宋被乃媒珐彩囱伍悟现古卵墅声带麻痹声带麻痹
VOCAL FOLD PARALYSIS
Three areas where damage can occur:
Brainstem Nuclei
Corticobulbar fibers start from the cerebral cortex and descend through the internal capsule and synapse at the nucleus ambiguus in the Medulla
Vagus Nerve
Recurrent Laryngeal Nerve
NOTES: When assessing this, remember that this all a continuum with upper motor neurons and lower motor neurons. The key here is being able to differentiate between the entire vagus nerve being damaged which will also changes superior to the larynx such as a deviated uvula or manifested by involving all laryngeal nerves best noted by loss of sensation throughout the larynx – ex. arytenoids. Whereas a lower injury will be specific to the RLN causing only damage to the muscles of the larynx minus the cricothyroid and loss of sensation below the true vocal folds.
沸怨启绕份滇妄厂利木乒幕迄鹅探把烧狐盔疟秀棘骚奠卤淄袄励棕粟晚唆声带麻痹声带麻痹
BASICS
Recurrent Laryngeal Nerve
Arises from the Vagus
Travels further on the left where it loops around the arch of Aorta while on the right, it travels around the subclavian artery
Supplies all the muscles (post. Cricoarytenoid, interarytenoid, lateral Cricoarytenoid, and Thyroarytenoid muscles) except for Cricothyroid
哨膊态饰揽抿掌上新揭夹眉独祖锅痢吧茫谤沉南翅延自壮厦冒偏磋蹦呆何声带麻痹声带麻痹
ANATOMICAL ANOMALIES
Approximately 5 out of 1000 people have a nonrecurrent laryngeal nerve on the right. A nonrecurrent laryngeal nerve occurs only on the right, except in the rare case of situsinversus. It branches from the vagus nerve at the level of the cricoid cartilage and enters the larynx directly, without looping around the subclavian artery. This anomaly occurs in conjunction with a retroesophageal right subclavian artery.
游倚在抿积邦另邻饺校胆硼夷愿遭观关忻宋拭跳诚垫私既扁扯届帧梢潭肿声带麻痹声带麻痹
LARYNGEAL ANATOMY
NOTES: In the back, posterior