THROAT - Left vocal cord palsy

Surgical anatomy :
 The left recurrent laryngeal nerve travels a similar course to the right except that it travels deep into the thorax. The left recurrent laryngeal nerve is situated more deeply in the tracheaoesophageal groove and medial to branches of the inferior thyroid arteries. It arises on the anterior surface of the arch of aorta.

What is the Aetiology of left vocal cord palsy?

Usually seen in adults

Sex : Both sexes are equally affected

Causes:
1) Malignancy of oesophagus
2) Aortic aneurysm
3) Thyroid surgery
4) Radical neck dissection
5) Thoracic surgery
6) Metastatic lymph nodes
7) Bullet wound
8) Pneumonectomy
9) Scalene node biopsy

What are the clinical features of left vocal cord palsy?

The voice of the patient may be slightly hoarse or unaffected.
Respiration and swallowing are normal.
On indirect laryngoscopy, the vocal cords maybe in median or paramedian position depending if the patient has unilateral abductor cord palsy or unilateral abductor and adductor cord palsy.

What investigations are required for the diagnosis of left vocal cord palsy?

1)      Routine blood investigation
2)      ESR for tuberculous
3)      VDRL for syphilis
4)      X-ray chest for mediastinal lesions, tuberculosis and
aortic aneurysms.
5)      CT Scan to detect intracranial lesions mediastinal lesions and
chest lesions
6)      Barium swallow for oesophageal malignancy
7)      Pan endoscopy : This includ e, direct laryngoscopy                oesophagoscopy, bronchoscopy and sinoscopy to detect a
malignancy.
8)      Fine needle aspiration cytology : Done to diagnose the type of
tumour especially in neck masses and thyroid growth
9)      CT guided FNAC tests are also done for deep situated lesions

What is the treatment of left vocal cord palsy?

1) Treat the specific cause if any
2) If patient asymptomatic no treatment is required
3) Speech therapy to improve the voice

 

Surgical:
Cord medialization procedures:
1.       Thyroplasty: The paralysed vocal cord is medialised by silastic
implant.
2.       Teflon paste infection is injected over the paralysed cord to push
it medially. This is done by microlaryngoscopy.

 

 




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