The variation in the course and direction of the recurrent laryngeal nerve on the right and on the left side may be explained on an embryologic basis. As the heart and the great vessel of the chest, the aorta, descend from their point of origin behind the face, they carry this nerve with them. This is also applicable to the descent of the right subclavian artery. Both of the recurrent nerves have their point of origin in close proximity to the vessels just mentioned. They are carried downward by the descent of these structures during embryonic life. This can be demonstrated in the presence of an anomalous position of these vessels. Such a condition is accompanied by an anomalous location of the respective nerves.1 From this brief description of the embryology, the variability that the recurrent nerve may assume can be appreciated. Gross deviations are rare; slight modifications are not uncommon.Pemberton and Beaver2 reported a case in which the right recurrent nerve was found at thyroidectomy to arise from the cervical portion of the vagus on a level with the superior pole of the thyroid gland. Milianitch3 reported a similar case. The nerve is usually described as supplying all of the intrinsic muscles of the larynx except the cricothyroid. Its importance in phonation and respiration is academic knowledge.
The pioneer work of Cushing,' Frazier, Royle," Adson and his co-workers" on the cerebrospinal, sympathetic and parasympathetic nervous systems is well known. Langley,' Kuntz" and others have contributed to our knowledge of the finer anatomy and physiology of this problem. The postoperative results in scleroderma, Raynaud's, Buerger's and in Hirschsprung's disease, by section of a portion of the lumbar sympathetic has stimulated further investigation.Though the sympathetic, parasympathetic and cerebrospinal nervous systems are very closely related to the ear, nose and throat, this relationship (especially the anatomic) is extremely difficult to utilize surgically. The observations of the pathology have been bacteriologic rather than neurologic. By contrast the lumbar sympathetic plexus and ganglia are relatively simple, likewise the stellate ganglion in the field of the thoracic or general surgeon. It is evident the nearer one gets to the central nervous system, the more difficult becomes the surgical approach to the various plexuses, ganglia and nerve fibers related to the sympathetic and parasympathetic. A few bold pioneers have blazed the trail. A small number of them have been otolaryngologists. Sluder" probably did most to stimulate members of the specialty to realize the importance of the relationship of nervous disturbances. Fenton and Larsell' have attempted to place the embryology and histology of some of the nerves related to the sphenopalatine ganglion on a sound scientific basis. Ruskin" has shown the relationship of neurogenic disturbances to clinical nasal pathology. Abroad Muller," in his excellent text, has added new light. Many years ago the researches of jonnesco'" stimulated great activity in the field of the sympathetics and their relation to clinical surgery;"
The ventricles of the larynx are two horizontal elliptic spaces situated on the inner aspect of the ala of the thyroid cartilage. They lie between the true vocal cord below and the so-called false vocal cord or ventricular band above ( fig. 1). Ventricular prolapse per se is a rare condition. It was first described by Lefferts in 1876. Since that time it has been a matter of controversy in the realm of laryngology. The great difference of opinion seems to be concerning the terminology and the etiology.
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