Pathogenesis (development of disease)
The recurrent laryngeal nerve is a branch of the vagus nerve. The laryngeus recurrens nerve dextra (right) runs its course around the subclavian artery (subclavian artery), then along the trachea (windpipe) and behind the thyroid gland to the larynx. The larygeus recurrens sinister nerve (left) loops around the aortic arch in its course, then pulls back between the esophagus (food pipe) and trachea (windpipe) to the larynx.
The laryngeal recurrent nerve motorically innervates most of the laryngeal muscles. Sensitively, it innervates the larynx below the glottis.
In unilateral recurrent paresis, the vocal cord of the affected side is paramedian, i.e., it remains immobile in the middle position. This causes a (sometimes only discretely pronounced) hoarseness (dysphonia). The ability to sing is lost. The voice sounds breathy or hoarse. In bilateral (“bilateral”) recurrent paresis, there is a median position of both vocal cords. This leads to typical symptoms such as severe dyspnea (shortness of breath), inspiratory stridor (breathing sound when inhaling) and hoarseness (discrete). Speaking is now only possible without a voice.
Etiology (causes)
Disease-related causes
Cardiovascular (I00-I99).
- Aortic aneurysm – bulging of the wall of the aorta (main artery).
- Left heart failure (left heart weakness)
Neoplasms – tumor diseases (C00-D48)
- Direct infiltration of the nerve by thyroid carcinoma (thyroid cancer, lat. Struma maligna) or regional tumors, unspecified.
- Mediastinal tumors (especially left-sided).
- Metastases (daughter tumors), especially in bronchial carcinoma (lung cancer).
Psyche – Nervous System (F00-F99; G00-G99).
- Neuritis (inflammation of the nerves)
- Paresis (paralysis), neurological conditioned.
Injuries, poisonings, and certain other sequelae of external causes (S00-T98).
- Trauma (injuries)
Operations
- Anterior spinal surgery (21% of iatrogenic paresis).
- Parathyroid surgery (6.8% of all surgically induced recurrent paresis)
- Aortic arch surgery (6.8% of all surgically triggered recurrent injuries)
- Thyroid surgery (e.g., goiter surgery, v. a. recurrent surgery; thyroidectomy) (50.6% of cases; 44.4% of all surgically triggered recurrent damage)
- Esophageal surgery (5.6% of all surgically induced recurrent damage).
Other causes
- Intubation complications (complications caused by insertion of an endotracheal tube (called a tube for short; it is the breathing tube, a hollow plastic probe) into the trachea (windpipe)).
- Idiopathic (without apparent cause) (21.6% )