Combined paralysis of the larynx. This pathology is generally due to a superior vagal lesion in the jugular foramen region or a bulbar lesion; however, the combined lesion of the recurrent nerve and the motor branch of the superior laryngeal nerve may be the result of thyroid surgery.
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- 1 Etiology
- 2 Clinical manifestations
- 3 Diagnosis
- 4 Treatment
- 5 Sources
Most peripheral laryngeal paralyzes, as they are also called, originate from traumatic injury to the laryngeal nerve (s).
Due to the long path of both vagus nerves to the emission of the superior and inferior laryngeal nerves, and the path of these from their origin in the vagus nerve to their distribution in the laryngeal muscles, mainly the left inferior laryngeal nerve, are susceptible to be injured by many causes.
In the past, the most frequent cause was thyroid and paratyphoid removal surgery, as well as Cardiovascular and thoracic surgery .
The symptoms are those of insufficient glottis, due to the intermediate position of the vocal cords . Symptoms in this position are persistent. Except in the case of acute recurrent nerve palsy , in which they tend to improve spontaneously.
Given that early recurrent nerve palsy and combined paralysis present the same clinical symptoms, it is important to establish a differentiation between the two, from the prognostic and diagnostic points of view . Except in patients who have had a thyroidectomy or after neuritis, combined paralysis is usually part of an associated paralysis.
Superior vagal lesions caused by neuritis generally cause sensory disturbances that can be easily observed. Consequently, the diagnostic problem is the one presented in general by the thyroidectomized patient. The picture of the oblique glottis due to superior laryngeal paralysis may be unclear, especially if compensation for the working chord has been established.
In unilateral paralysis, manipulation tests and the determination of alterations of the cricothyroid space may be useful, although not conclusive. The electromyographic analysis of the cricothyroid muscle is performed without difficulty transcutaneously, achieving a relatively easy determination of the state of the cricothyroid muscle.
Initial treatment includes the therapy of voice and physiotherapy , however, compensation is often less than required and may require surgery for abduction of the vocal cord.