Superior laryngeal neuralgia

Reported by O.R.Ganeshamurthi

Introduction
‡ The superior laryngeal nerve is a branch of the vagus nerve. It arises from the middle of the ganglion nodosum and in its course receives a branch from the superior cervical ganglion of the sympathetic

Introduction
‡ It descends, by the side of the pharynx, behind the internal carotid artery, and divides into two branches: ‡ external laryngeal nerve ‡ internal laryngeal nerve

External laryngeal nerve

‡ Functions : tense the vocal cords by activating the cricothyroid muscle, increasing pitch.

Role of cricothyroid muscle in phonation: Contraction of cricothyroid muscle tilts the cricoid lamina backward at the cricothyorid joint causing lengthening, tensing and adduction of vocal folds causing an increase in the pitch of the voice generated.

Internal laryngeal nerve
‡ Function : sensory branches to epiglottis, base of the tongue, and the epiglottic glands supply the mucous membrane surrounding the entrance of the larynx, and that lining the cavity of the larynx as low down as the vocal folds.

What is Neuralgia ?
‡ Neuralgia is an acute pathological nerve condition characterized by an intense and frequent, yet intermittent pain that radiates along the length of one or more nerves.

Axis 1 physical conditions Neuropathic pain

Episodic pain Paroxysmal neuralgia

Superior laryngeal neuralgia

Superior Laryngeal Neuralgia
Causes of superior laryngeal nerve paralysis: 1. Surgical 2. Neurulogical (5-10%) 3. Oesophageal tumors 4. Trauma

Causes of superior laryngeal nerve paralysis
5. Inflammatory 6. Infectious 7. Idiopathic (20-25%)

Unilateral Superior Laryngeal Nerve Injury
‡ Loss of sensation to the supraglottic larynx can cause subtle symptoms such as frequent throat clearing, paroxysmal coughing, voice fatigue, vague foreign body sensations

Bilateral Superior Laryngeal Nerve Injury
‡ Fortunately, it is rare. It can result in severe aspiration with subsequent pneumonia.

Symptoms and Signs
‡ paroxysms of shock-like pain ‡ pain radiates into the upper thorax or up into the jaw ‡ trigger zone is usually in the larynx; attacks are precipitated by talking, swallowing, yawning, or coughing

Symptoms and Signs
‡ patient might have hiccups, inspiratory stridor, excessive salivation, or coughing ‡ combination of glossopharyngeal and vagal as well as trigeminal pain has been reported

Symptoms and Signs
About voice 1. Raspy voice 2. Voice fatigue 3. Volume deficit 4. Loss of singing volume

Diagnosis
1. History * Typical complaints * Character of a patient with Superior Laryngeal Nerve Injury

Investigation
1. Vocal capabilities Speaking voice Yelling voice Maximum phonation time Pitch range

Investigation
2 . Laryngeal Exam Rigid laryngoscope Flexible laryngoscope Neck exam

Treatment
‡ Unilateral Vocal Cord Paralysis: 1) Speech therapy 2) Surgical medicalization 3) Intracordal injection 4) Selective reinnervation

Treatment
‡ Bilateral Vocal Cord Paralysis: 1) tracheotomy 2) vocal cord lateralization 3) reinnervation

Treatment
‡ pharmacologic treatment ‡ Surgery

Name : Aishwarya Rai place : India Miss World in 1994