Thursday, July 4, 2013

7/4/2013

Answers:

With regards to unilateral recurrent laryngeal paralysis, how long does it take, on average for a patients voice to compensate for the paralyized cord and regain some function?
A) 1-6 months 
B) 6-18 months 
C) 2-3 years 
D) They never compensate

In unilateral complete vagal paralysis, what treatment modality is preferred; injection laryngoplasty or laryngeal framework using a silastic implant?
Laryngeal framework, injection laryngoplasty often cannot medialize the cords sufficiently given their lateral position.

MC Question:
The recurrent laryngeal nerve enters the larynx underneath what muscle?
A) Cricothyroid 
B) Posterior Cricoarytenoid 
C) Inferior Constrictor 
D)Superior Constrictor

Free Response Questions:
How do patient's with bilateral recurrent laryngeal nerve paralysis typically present?

Quick Facts:
Unilateral Complete Vagal Paralysis
-injury above origin of superior laryngeal nerve
-due to loss of superior laryngeal nerve function there is decreased sensation (pt often has hx of aspiration) and cricothyroid is immobile.
-Paralyzed cord lies laterally.
-Due to many causes:
-iatrogenic = surgery
-neurologic = MS, syringomyelia, encephalitis
-infarct = wallenberg syndrome
-malignancy
-inflammation = skull base osteomyelitis
-compensation is usually inadequate so voice is breathy.
-often accompanied by other CN involvement.
-Injection laryngoplasty is often inadequate.
-best treatment is medialization using silicone implants.

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