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Flashcards in Laryngeal Paralysis Deck (18):

Medulla Oblongata contains nerves innervating....

Palate, tongue, pharynx, larynx
Peripheral pathways to the laryngeal muscles
Bilateral or unilateral


Muscle Tone related to LMN

Flaccid or atrophy


Vagal Nerve Damage at its Origin may be Caused by...

Trauma to brainstem b/c of an accident
Surgery in the medulla oblongata
Tumor pressing on lower brainstem


Causes of Recurrent Laryngeal Nerve Damage

Neck tumors, aortic aneurysm, external injuries, enlarged thyroid gland, thyroid operation, anterior approach to cervical spinal cord surgery
Things in the periphery
Larynx can look tilted and rotated from damage on last bullet point
Left side is longer and loops under aorta
Right side loops under subclavian artery (Can be affected by tumors in the chest)


Paralysis Types

Unilateral vagus nerve lesion
Bilateral vagus nerve lesion
Unilateral recurrent nerve lesion
Bilateral recurrent nerve lesion
Unilateral superior laryngeal nerve lesion
Bilateral superior laryngeal nerve lesion
Unilateral abductor paralysis
Bilateral abductor paralysis

Vagus, recurrent, superior, and abductor types


Unilateral Vagus Nerve Lesion (nucleus)

Above origin of pharyngeal, superior laryngeal, & recurrent laryngeal nerves
VF fixed in abducted position
Soft palate paralyzed
Vocal quality exhibits hoarseness, breathiness, poor pitch control, & hypernasality


Bilateral Vagus Nerve Lesion

Both cords fixed in the abducted position on phonation
Soft palate paralyzed bilaterally
Vocal quality aphonic & hypernasal


Unilateral Recurrent Paralysis

Most common paralysis
Adductors & abductors paralyzed
Cord lies in the paramedian position
Vocal quality dysphonic with severe breathiness (will have to train)
Compensation: did they get the closure & did they get good voice?
Progress with a pt with paralysis: voice would get less breathy


Bilateral Recurrent Paralysis

Both adductors & abductors paralyzed
Both cords lie in paramedian position
Vocal quality aphonic
Difference between breathiness (breathy override over voice) in the voice and aphonia (no voice at all)
Poor prognosis (no surgery will help either)


Thyroarytenoid Muscle Paralysis Tx

Try to change pitch some how by lengthening VFs (adduct)—strengthening can help--/i/, /i/, /i/ (diadochokinetic)
Rationale: strengthen VFs and close VFs with a higher pitch
Procedure: hard glottal attack & staccato /i/ productions
If it’s just SLN (pitch), adductors are intact


Unilateral Abductor Paralysis

Unilateral posterior cricoarytenoid paralyzed
Affected cord lies in a central position
Arytenoid tilted forward
Phonation rarely affected
Half of the airway occluded
Ends up being a breathing problem and not a phonation problem
Lateralize that cord—reduced phonation (either want to talk or breathe)


Bilateral Abductor Paralysis

Bilateral posterior cricoarytenoid paralyzed
Both cords lie in a central position
Airway totally obstructed
Pronounced laryngeal stridor
Voice unaffected


Damage to the Superior Laryngeal Nerve

Trauma, surgery, tumors, stretching, compression, lacerations


Tracheal Compression Sx's

Throat clearing, sensations of pain & pressure, difficulty in swallowing, lowered speaking pitch, inability to produce high pitch in singing


Unilateral Superior Laryngeal Nerve Paralysis

Cricothyroid affected
Slacked cord produces a hoarse rough vocal quality
Front tension (anterior cricothyroid)--bowing


Bilateral Superior Laryngeal Nerve Paralysis

Cricothyroid paralyzed on both sides
Vocal quality is hoarse, drops in pitch, lacks inflection


Damage to Posterior Cricoarytenoid Muscle

Nerve vs. trauma from intubation


Laryngoplasty--Surgery to fix

Started with teflon, then went to gel foam, then went to fat (best—from person’s body—softest impact—harmonic isn’t that impact), also use collagen