Page 1 of 2: ENT---b/l RLN palsy

ruchi · Credits: 2738 My Scrapbook

b/l RLN palsy presents as
a]aphonia but no resp. problem
b]stridor&aphonia
c]no change in voice
d]depends onsite of lesion
plz. xplain...[ans. given is c but it shud b "b"]

doctorgirl78 · Credits: 5366 My Scrapbook

Dhingra says,,,,,,,,
b/l recurent laryngeal nerve palsy ,airways are inadequate causing dyspnoea & stridor but the voice is good.,Dyspnoea & stridor become worse on exertion or during an attck of acute laryngitis.

neodoc · Credits: 2306 My Scrapbook

in bilateral RNL palsy is correct.

Reference on the net is given under potential complications of thyroidectomy at [url]http://www.sohnnurse.com/thyroidectomy.html

Following is a part of the matter given:

Laryngeal Nerve Injury
Injury that results from severing, clamping, compressing, or stretching either the RLN or SLN during thyroid surgery may result in severe untoward sequelae for the patient. Varying degrees of symptoms result depending on the combination of SLN and RLN injury. Bilateral RLN injury is a severe life-threatening complication that results in airway obstruction and requires immediate attention. In this condition, both vocal cords remain in a median or paramedian position. As a result, the patient exhibits inspiratory stridor, dyspnea, tachypnea, and nasal flaring, although the voice is near normal.Unilateral RLN injury causes the ipsilateral vocal cord to remain in the median or paramedian position. The voice may be hoarse and breathy. The patient's cough is weak, and aspiration may occur. Aspiration is more likely to be a problem when combined with SLN injury (Fredrickson & Paniello, 1993). Damage to the SLN affects voice pitch. Since the cord is unable to lengthen and tense, the voice is low in pitch and breathy in quality. Combinations of RLN and SLN injury may occur with varying degrees of severity of symptoms.

ruchi · Credits: 2738 My Scrapbook

hey thanks neodoc
actually Mr. B D Chaurasia left me all confused ;he said "when both RLN's are inturrepted, the vocal cords lie in cadaveric position & phonation is completely lost. breathing also becomes difficult through the partiall opened glottis."
anyway thanks again !!

Bruno · Credits: 44695 My Scrapbook My Reading List 50 Books

S.No
Positions of Cord
Distance from Midline
Phonation
Nerve Affected

1
Median
0 mm (Reference Point)
Normal Phonation
Recurrent Laryngeal nerve

2
Para Median
1.5 mm from Midline
Strong Whisper
Recurrent Laryngeal nerve

3
Cadaveric ( Intermediate)
3.5 mm from Midline
-----------
Both Nerves

4
Slight Abduction
7 mm from Midline
Quite Respiration
Adductor paralyisis S L N

5
Full Abduction
9.5 mm from Midline
Quite Respiration
Full Adductor paralyisis S L N

Bruno · Credits: 44695 My Scrapbook My Reading List 50 Books

Adductor Paralysis

Functional Adductor Paralysis - Vocie is Faint Whisper
Organic Adductor Paralysis - Voice is Forced Whisper

Bruno · Credits: 44695 My Scrapbook My Reading List 50 Books

SLN Palsy

Unilateral SLN - Voice is weak
Bilateral SLN - Food goes into Trachea

decembermist · Credits: 41071 My Scrapbook

after readin this im confused!!

ans shud be b) right !!!

BRAVO · Credits: 45411 My Scrapbook

ANS IS DEFINATELY B.

entconsultant · Credits: 2074 My Scrapbook

how come BRAVO??
when the cord is in median or paramedian position voice will be normal or near normal. but with inadequate airway.

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