13.03.14 ENT clinic notes
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