Recurrent laryngeal nerve, symptoms of injury and paresis
The main function of the recurrent laryngeal nerve is the innervation of the laryngeal muscles, as well as the vocal cords along with providing their motor activity, and in addition, the sensitivity of the mucous membrane. Damage to nerve endings can cause disruption of the speech device as a whole. Also, due to such damage, the respiratory system may suffer.
Laryngeal dysfunction: clinical manifestations and causes of the disease
Often damage to the recurrent laryngeal nerve, which in medicine is called neuropathic paresis of the larynx, is diagnosed on the left side as a result of the following factors:
- Postponed surgical manipulation on the thyroid gland.
- Postponed surgical manipulation on the respiratory system.
- Postponed surgical manipulation in the area of the main vessels.
- Viral and infectious diseases.
- Vascular aneurysm.
- Presence of oncological tumors of the throat or lungs.
Other causes of the recurrent laryngeal nerve are also various mechanical injuries along with lymphadenitis, diffuse goiter, toxic neuritis, diphtheria, tuberculosis and diabetes mellitus. Left-sided lesion, as a rule, explains the anatomical features of the position of nerve endings, which can be traumatized due to surgical intervention. Congenital paralysis of ligaments can be found in children.
Inflammation of nerve endings
Against the background of the pathology of the recurrent guttural nerve, nerve endings are inflamed, which occurs as a result of some transferred viral and infectious diseases. The reason may be chemical poisoning along with diabetes, thyrotoxicosis and a deficiency of potassium or calcium in the body.
Central paresis can also occur against the background of brain stem cell damage, which is caused by cancerous tumors. Another cause can serve as an atherosclerotic lesion of vessels, and in addition, botulism, neurosyphilis, poliomyelitis, hemorrhage, stroke and severe trauma to the skull. In the presence of cortical neuropathic paresis, bilateral nerve damage is observed.
As part of the surgical operations in the larynx, the left recurrent laryngeal nerve can be accidentally damaged by some instrument. Excessive pressure with a tissue during operations, compression of the suture material, formed hematomas can also damage the laryngeal nerve. In addition, there may be a response to anesthetics or disinfectant solutions.
Symptoms of nerve damage
The following symptoms are the main symptoms resulting from damage to the recurrent laryngeal nerve:
- Difficulties in trying to pronounce sounds, which is manifested in the hoarseness of the voice and the decrease in its timbre.
- Development of dysphagia, in which ingestion of food becomes difficult.
- Whistling, and besides, noisy breaths of air.
- Full loss of voice.
- Choking on the background of bilateral nerve damage.
- Having shortness of breath.
- Violation of the general mobility of the tongue.
- Loss of sensitivity of the soft palate.
- Feeling of numbness of epiglottis. In this case, food can get into the larynx.
- Development of tachycardia and high blood pressure.
- With the development of a bilateral paresis, noisy breathing can be observed.
- The presence of a cough with the thumping of gastric juice in the larynx.
- Respiratory distress.
Peculiarities of the condition of patients on the background of damage to the recurrent laryngeal nerve
If the return nerve is not dissected during the operation, then the speech will be able to recover in two weeks. Against the background of a partial crossing of the right recurrent laryngeal nerve, the recovery period, as a rule, takes up to six months. The symptomatology of numbness of the epiglottis disappears within three days.
Surgery for both lobes of the thyroid gland can lead to bilateral nerve paresis. In this case, paralysis of the vocal cords may form, as a result of which a person can not breathe on his own. In such situations, it may be necessary to apply a tracheostomy - an artificial hole on the neck.
Against the background of a bilateral paresis of the recurrent nerve, the patient is constantly in a sitting position, and the skin covers are pale in color, and the fingers and toes are cold at the same time, in addition, a person may experience a sense of fear. Attempting to perform any physical activity leads only to a deterioration in the condition. After three days, the vocal cords may occupy an intermediate position and form a small gap, and then breathing normalizes. But nevertheless, during any movements, the symptoms of hypoxia return.
Cough along with permanent damage to the mucous membranes of the larynx can lead to the development of inflammatory diseases such as laryngitis, tracheitis and aspiration pneumonia.
Methods of diagnosing the disease
Anatomy of the recurrent laryngeal nerve is unique. Precisely to establish damage it will be possible only after consultation at the doctor-otolaryngologist. In addition, you will need an examination from such specialists as neurologist, neurosurgeon, pulmonologist, thoracic surgeon and endocrinologist. Diagnostic examinations against the background of the laryngeal paresis are performed as follows:
- Conducting an examination of the patient's larynx, as well as collecting an anamnesis.
- Computer tomography.
- X-ray of the larynx in a straight line and in the lateral projection.
- As part of the laryngoscopy, the vocal cords are in the middle position. During the conversation, the increase in the glottis does not occur.
- Conducting a phonetography.
- Performing electromyography of the muscles of the larynx.
- Carrying out a biochemical blood test.
Additional diagnostic procedures may require computed tomography and ultrasound. It is not superfluous for the patient to undergo roentgenography of the brain, respiratory system, thyroid, heart and esophagus.
Differentiation of paresis from other diseases
It is extremely important to be able to differentiate the paresis of the laryngeal nerve from other diseases that also cause respiratory failure. These include:
- Clogging of vessels.
- Appearance of a stroke.
- The development of multiple systemic atrophy. Attacks of bronchial asthma.
- The development of myocardial infarction.
Against the backdrop of bilateral paresis, as well as in severe conditions in patients and attacks of suffocation, first of all, emergency care is provided, after which the diagnosis is carried out and the necessary therapy is selected.
Classification of symptoms for this ailment
Based on the results of the diagnostic measures, and in addition, the examination of patients with all the symptoms of damage to the recurrent nerve is divided into the following states:
- The development of unilateral paralysis of the left recurrent nerve manifests itself in the form of pronounced hoarseness, dry cough, dyspnoea during conversation andafter physical exertion. In addition, while the patient can not talk for a long time, and directly during meals can choke, sensing the presence of a foreign object in the larynx.
- Two-sided paresis is accompanied by shortness of breath and attacks of hypoxia.
- A condition that mimics paresis is formed against a background of unilateral nerve damage to the larynx. In this case, on the opposite side, a reflex spasm of the vocal fold can be observed. It is difficult for a patient to breathe, he can not clear his throat, and during food he chokes on food.
Reflex spasms can develop due to a deficiency of calcium in the blood, a condition that is common in people who suffer from thyroid disease.
What will be the treatment for the recurrent laryngeal nerve?
Methods of treatment of pathology
The paresis of the laryngeal nerve is not considered a separate disease, therefore its treatment begins, first of all, with elimination of the main causes that cause this pathology. As a result of the growth of cancerous tumors, the patient needs surgical removal of such tumors. A enlarged thyroid gland is subject to mandatory resection.
Emergency care is required for patients with a bilateral paresis, otherwise asphyxia can occur. In such situations, tracheostomy is performed for the patient. Such an operation is performed under local or general anesthesia. In this case, a special cannula and tube is inserted into the trachea, which is fixed with the help of Chassignac's hook.
Drug treatment for the recurrent laryngeal nerve involves the use of antibiotics along with hormonal drugs, neuroprotectants and group B vitamins. In the event that there is an extensive hematoma, funds are allocated that accelerate the resorption of bruises.
Reflex therapy is performed by acting on sensitive points that are located on the surface of the skin. Such therapy restores the work of the nervous system, accelerating the regeneration of damaged tissue. The voice and vocal function is normalized by special training with a phoniatric doctor.
Against the background of a prolonged violation of voice functions, atrophy can occur along with a pathology of functioning of the larynx muscles. In addition, fibrosis of the metacarpal joint can form, which will impede the restoration of speech.
In case of ineffectiveness of conservative treatment, as well as against a background of bilateral recurrent nerve paresis, patients are prescribed a reconstructive operation to restore respiratory functions. Surgical intervention is not recommended in the elderly, and in addition, in the presence of malignant thyroid tumors or severe system pathologies.