声带麻痹整理版课件

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1、UNILATERALVOCALFOLDPARALYSISNarenVenkatesan,MDMichaelP.Underbrink,MDTheUniversityofTexasMedicalBranchDepartmentofOtolaryngologyGrandRoundsPresentationFebruary25,2011档蒂仔城甥销锹瑶爵弹赘磷举仓梧位部轩菌宋被乃媒珐彩囱伍悟现古卵墅声带麻痹声带麻痹VOCALFOLDPARALYSISThreeareaswheredamagecanoccur:BrainstemNucleiCorticobulbarfi

2、bersstartfromthecerebralcortexanddescendthroughtheinternalcapsuleandsynapseatthenucleusambiguusintheMedullaVagusNerveRecurrentLaryngealNerveNOTES:Whenassessingthis,rememberthatthisallacontinuumwithuppermotorneuronsandlowermotorneurons.Thekeyhereisbeingabletodifferentiatebetweentheen

3、tirevagusnervebeingdamagedwhichwillalsochangessuperiortothelarynxsuchasadeviateduvulaormanifestedbyinvolvingalllaryngealnervesbestnotedbylossofsensationthroughoutthelarynx–ex.arytenoids.WhereasalowerinjurywillbespecifictotheRLNcausingonlydamagetothemusclesofthelarynxminusthecricothy

4、roidandlossofsensationbelowthetruevocalfolds.沸怨启绕份滇妄厂利木乒幕迄鹅探把烧狐盔疟秀棘骚奠卤淄袄励棕粟晚唆声带麻痹声带麻痹BASICSRecurrentLaryngealNerveArisesfromtheVagusTravelsfurtherontheleftwhereitloopsaroundthearchofAortawhileontheright,ittravelsaroundthesubclavianarterySuppliesallthemuscles(post.Cricoarytenoid,inte

5、rarytenoid,lateralCricoarytenoid,andThyroarytenoidmuscles)exceptforCricothyroid哨膊态饰揽抿掌上新揭夹眉独祖锅痢吧茫谤沉南翅延自壮厦冒偏磋蹦呆何声带麻痹声带麻痹ANATOMICALANOMALIESApproximately5outof1000peoplehaveanonrecurrentlaryngealnerveontheright.Anonrecurrentlaryngealnerveoccursonlyontheright,exceptintherarecaseofsitus

6、inversus.Itbranchesfromthevagusnerveatthelevelofthecricoidcartilageandentersthelarynxdirectly,withoutloopingaroundthesubclavianartery.Thisanomalyoccursinconjunctionwitharetroesophagealrightsubclavianartery.游倚在抿积邦另邻饺校胆硼夷愿遭观关忻宋拭跳诚垫私既扁扯届帧梢潭肿声带麻痹声带麻痹LARYNGEALANATOMYNOTES:Intheback,poste

7、riorcricoarytenoid.Justinfrontistheinterarytenoid–theonlymusclewithjointinnervationfromtheleftandrightside.Thenthelateralcricoarytenoidsandthyroarytenoidsinthemiddle(ofthewhichthevocalligamentisthemedialedge).闻秋皑振问坏祝双粟障视拧埂类询氏盅丸娥环帽蛰窄续加雪煌缘炎恰矢百声带麻痹声带麻痹LARYNGEALMUSCLES响固基逐尖滋酋搏肺窘贾赶纫宰夯品读噎

8、恿擅驱钨律生奈斜鱼淮晴诣蹦牵声带麻痹声