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


    • Vocal cords have ciliated columnar epithelium

      • Trauma (smoke etc) converts to squamous epithelium

    • SCC is by far the commonest cancer in the neck