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A D V E R T I S E M E N T
A D V E R T I S E M E N T
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During quiet respiration, the cords abduct a short distance during inspiration and adduct during inspiration. In deep inspiration, the cords are maximally abducted. This movement is indicative of intact recurrent laryngeal nerve function during perioperative and intraoperative laryngoscopy. Adduction of the cords with phonation is also assessed in the awake patient.
A D V E R T I S E M E N T
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Total division of one recurrent laryngeal nerve usually leaves the paralyzed vocal cord (left injury illustrated) midway between ab- and adduction. Respiration is not dramatically affected, and normal speaking may not be obviously impaired, especially if the functioning cord compensates to the opposite side. Recurrent laryngeal nerve injury may also occur late (see discussion) due to edema or devascularization of vasa nervorum during surgical visualization of the nerves.
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A D V E R T I S E M E N T
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Partial nerve injury may result in unequal denervation, with greater effect on abduction than adduction. This may be due to disposition of nerve fibers or greater innervation of the abductors than the adductors. The result is a paralyzed cord that remains in the adducted position.
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