21/12/2022
Larynx এর nerve supply টা clinically অনেক important।
শুরুতে নিচের ছবিগুলো দেখো। তারপর problem টা solve করো।
Scenario:
55-year-old man is admitted to the emergency department with a complaint of pain when chewing over the previous 3 months.
Physical examination reveals the
patient suffers from odynophagia (painful swallowing) and some hoarseness in his speech.
Radiographic examination reveals a tumor at the tracheoesophageal groove.
Which of the following nerves is most likely affected by the tumor?
A. Recurrent laryngeal
B. Internal laryngeal
C. Vagus
D. External laryngeal
E. Phrenic
Additional info:
The innervation of the larynx is intricate, detailed, and represents some of the more complex relationships in the anatomy of the head and neck.
The vagus nerve is the large nerve that supplies the many branches of nerves that innervate the larynx.
The superior laryngeal nerve, its external and internal branches, and the recurrent laryngeal nerve all have very distinct roles in motor and sensory innervation of the larynx.
Superiorly, sensory and motor innervation are separated by internal and external branches of the superior laryngeal nerves. Inferiorly, the sensory and motor innervation is provided by the recurrent laryngeal nerve.
Damage to the recurrent laryngeal as a result of surgical intervention or the presence of a tumor in the tracheoesophageal groove would render the patient hoarse.
This hoarseness is due to a lack of innervation by the recurrent laryngeal nerve to most of the muscles of the larynx.
Damage to the internal laryngeal nerve would cause a loss of sensation above the vocal
cords, in addition to a loss of taste on the epiglottis.
Damage to the external laryngeal, which can occur during thyroidectomy, will result in a loss of innervation to the cricothyroid muscle, with resultant vocal weakness with a fatigued voice.