Things to remember about the RLN- Vocal cord paralysis is a sign not a diagnosis
- RLN palsy is only idiopathic if you've scanned all the way down to the diaphragm
- Bit like Bell's palsy
- Leave it six months as it may recover
- After that can surgically move and fix the vocal cord to restore voice
- Left is more commonly affected that right as it has a longer course
- If the palsy is due to cancer they're in trouble
- Impingement typically comes from mediastinal lymph node, not from the primary
- RLN has sensory as well as motor functions
- Patients can't feel their swallow => Risk of choking and aspiration
- Aspiration pneumonia is the most common cause of death
Causes of horse voice
- Inflammatory
- Bacterial
- TB and syphilis are the big historical causes
- Viral
- Traumatic
- Granuloma after prolonged intubation
- Direct trauma
- Vocal cord nodules
- These are not neoplastic - just due to oedema and inflammation
- Neoplastic
- Benign
- Malignant
- T1 = One side of the cords only
- T2 = Involving anterior commisure and both sides
- T3 = Local invasion
- T4 = Distant spread
- RLN palsy
- Other rare causes
- Reinke's edema: Swelling of the vocal folds due to oedema in superficial lamina propria of vocal cords (Reinke's space) due to:
- Smoking
- GORD
- Hypothyroidism
- Chronic voice abuse
- Psychogenic (test with distraction during endoscopy)
Frey's syndrome
- Causes Gustatory Sweating
- Results as a side effect of parotid gland surgery or due to injury to auricotemporal nerve
- Following damage the parasympathetic fibres regenerate in the wrong direction and make their way to the skin where they inappropriately innervate sweat glands
Nerve branches
- Trigeminal
- Ophthalmic
- Maxillary
- Mandibular
- Facial
- Two - Temporal
- Zulus - Zygomatic
- Buggered - Buccal
- My - Mandibular
- Cat - Cervical
Notes
- Vocal cords have ciliated columnar epithelium
- Trauma (smoke etc) converts to squamous epithelium
- SCC is by far the commonest cancer in the neck
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