AIIMS NOV 14 Most common cause of vocal cord palsy is a. Inflammatory b. Malignancy c. Neurological d. Surgical trauma Answer. D. Surgical Trauma. Ref. Sabiston textbook of surgery. Ch.33, Dhingra. Vocal cord paralysis may result from lesions at the nucleus ambiguus, its supranuclear tracts, the main trunk of the vagus, or the recurrent laryngeal nerves. RLN (recurrent laryngeal nerve paralysis) Semons law: This theory proposed by Rosenbach and Semon in 1881, depends on the concept that abductor fibres in the recurrent laryngeal nerves are more susceptible to pressure than the adductor fibers. Wagner and Grossman theory: This theory was first proposed by Wagner and Grossman (1897). This theory states that in complete paralysis of recurrent laryngeal nerve the cord lies in the paramedian position because the intact cricothyroid muscle adducts the cord. (Because the superior laryngeal nerve is intact) Unilateral vocal cord paralysis is most common. • Unilateral vocal cord paralysis: • Hoarseness, ineffective cough, dysphagia, aspiration, • Completely asymptomatic because of their ability to compensate. • Definitive diagnosis is made via laryngoscopy, and subtle weakness may require stroboscopic examination. Causes of paralysis • Most common - surgical trauma (most commonly thyroidectomy); malignancies of the thyroid, mediastinum, esophagus, or larynx; mediastinal compression; viral neuropathy; collagen vascular disease; sarcoidosis; diabetic neuropathy. • Idiopathic – 20% Q Bilateral vocal cord paralysis is a life-threatening disorder caused by thyroid and cervical surgery, tracheal intubation, trauma, and neurodegenerative and neuromuscular diseases. Treatment • For unilateral paralysis, surgical procedures to move cords closer together • For bilateral paralysis, surgical procedures and measures to maintain airway Thyroplasty types – Mneumonic-Men Like Small Ladies. Type1 – Medialisation (Unilateral RLN) Type 2 – Lateralisation (for bilateral RLN palsy) Type 3 - Shortening of cord (for Puberphonia) Type 4 – Lengthening of cord #xpressnov14
Posted on: Thu, 18 Dec 2014 11:59:30 +0000