Parálisis de cuerdas vocales

The RLN carries both abductor and adductor fibers to the vocal cords.
The abductor fibers are more vulnerable, and moderate trauma causes
a pure abductor paralysis, whereas severe trauma causes both abductor
and adductor fiber injury. In pure unilateral abductor palsy, both
VC meet in midline during phonation because adduction can still occur
on the affected side. However, only one cord abducts during inspiration:
the unaffected one. By contrast, in complete unilateral RLN palsy
both abductors and adductors are affected, and the affected VC lies in a
paralyzed position midway between complete abduction and complete
adduction. During phonation, the unaffected VC crosses the midline to
meet the paralyzed cord. On inspiration, the unaffected
cord moves to full abduction. Bilateral RLN palsy produces a different
result. In incomplete bilateral abductor damage to the RLN, the adductor
fibers draw the VC toward each other, and the glottis opening is reduced
to a thin slit, which leads to significant respiratory distress. By contrast,
in complete bilateral palsy of the RLN each VC lies midway between adduction
and abduction, producing a moderate glottis opening. Therefore,
bilateral incomplete RLN palsy is more life threatening than complete
bilateral palsy.



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