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 tracheo-oesophageal groove and medial to branches of the inferior thyroid arteries. It arises on the anterior surface of the arch of aorta.
- Usually seen in adults.
- Sex: Both sexes are equally affected.
In the neck
- Accidental trauma.
- Benign thyroid disease.
- Malignant thyroid disease.
- Thyroid surgery.
- Carcinoma of cervical oesophagus.
- Cervical lymphadenopathy.
- Radical neck dissection.
- Bronchogenic carcinoma.
- Cancer of thoracic oesophagus.
- Aortic aneurysm.
- Mediastinal lymphadenopathy.
- Enlarged left auricle.
- Intrathoracic surgery.
- Thoracic surgery.
- Metastatic lymph nodes.
- Bullet wounds.
- Scalene node biopsy.
Carcinoma bronchus is an important cause of left recurrent paralysis and should always be excluded by HRCT chest, bronchoscopy and biopsy unless any other cause is obvious.
- The voice of the patient may be slightly hoarse or unaffected.
- Respiration and swallowing are normal. Some patients get cough on quick ingestion of fluids.
- 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.
- Stroboscopy is done to confirm the exact position of the vocal cords and any local lesions.
- Routine blood investigations including ESR.
- CT Scan to detect intracranial lesions, mediastinal lesions and chest lesions.
- VDRL for syphilis.
- X-ray chest for mediastinal lesions, tuberculosis and aortic aneurysms.
- Barium swallow for oesophageal malignancy.
- Panendoscopy: This includes direct laryngoscopy, oesophagoscopy, bronchoscopy and sinoscopy to detect a malignancy.
- Fine needle aspiration cytology: Done to diagnose the type of tumour especially in neck masses and thyroid tumours.
- CT guided FNAC tests are also done for deep situated lesions.
- Treat the specific cause if any.
- If patient asymptomatic no treatment is required.
- Speech therapy to improve the voice.
Cord medialization procedures:
- Teflon paste is injected over the paralysed cord to push it medially. This is done by microlaryngoscopy.
- Thyroplasty: The paralysed vocal cord is medialised by silastic implant.
- Vocal process of the arytenoid is rotated medially.