CAUSES OF VOCAL CORD PALSY

Surgical anatomy: The vagus nerve arises from the lateral surface of the medulla.

It gives rise to two main branches in the larynx namely:

  1. Superior laryngeal nerve- It further gives two branches namely:
    • Internal laryngeal nerve (sensory)- It supplies sensation to the mucosa from the epiglottis to just above the level of the vocal folds.
    • External laryngeal nerve- It gives motor supply to Inferior constrictor muscle and cricothyroid muscle
  2. Recurrent laryngeal nerve- It gives motor fibres to all laryngeal muscles except cricothyroid (motor) and supplies sensation to the rest of the larynx below the level of the vocal folds.

Motor Paralysis:

a) Cortical paralysis: These lesions are rare as the larynx has bilateral motor innervation. May be seen in cases of:

  • Congenital cerebral palsy.
  • Encephalitis.
  • Kernicterus.
  • Diffuse cerebral arteriosclerosis.

b) Corticobulbar paralysis: These are extremely rare due to paralysis of the corticobulbar tracts.

c) Bulbar paralysis: This is a flaccid type of paralysis due to destruction of all or part of nucleus ambiguous in the medulla.

  • Vascular insufficiencies such as vertebral or Postero-inferior cerebellar arteries.
  • Multiple sclerosis.
  • Intramedullary tumours like gliomas.

d) Peripheral causes: They are responsible for 90 percent of the vocal cord paralysis. The lesion involves the fibres of the laryngeal nerves from the surface of the medulla up-to the larynx. Usually combines with multiple cranial nerves.

Peripheral causes of vocal cord palsy: Inflammatory:
  1. Neuritis.
  2. Meningitis.
  3. Diphtheria.
  4. Herpes zoster.
  5. Tuberculosis.
  6. Jugular bulb thrombophlebitis.

Neoplastic:

  1. Meningioma.
  2. Glomus jugulare.
  3. Thyroid Malignancy.
  4. Thymus tumours.
  5. Malignant lymphoma.
Trauma:
  1. Blunt neck trauma.
  2. Bullet wounds.
  3. Fracture clavicle.
  4. Surgical trauma.
  1. Thyroidectomy.
  2. Tracheostomy.
  3. Radical neck dissection.
  4. Pneumonectomy.
Neuropathy Secondary to:
  1. Diabetes mellitus.
  2. Rheumatoid arthritis.
  3. Polyarteritis nodosa.
  4. Lead poisoning.

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