Pharyngeal Swallowing in Patients with Paresis of the Recurrent Nerve

Abstract

Pharyngolaryngeal function during swallowing was investigated cineradiographically in 22 patients with paresis of the recurrent nerve. Nineteen of these patients (86%) had defective closure of the laryngeal vestibule: 10 patients had defective apposition of the corniculate cartilages, (paresis of the oblique cricoarytenoid muscle), 9 patients had defective apposition of the arytenoid cartilages, (paresis of the interarytenoid muscle), 13 patients had defective movement of the epiglottis (paresis of, i.a. the thyrohyoid muscle), 1 patient had defective closure of the subepiglottic portion of the vestibule (paresis of the thyroepiglottic muscle), 2 patients had defective closure of the supraglottic portion of the vestibule (paresis of the superior ventricular segment of the thyroarytenoid muscle). Five patients with immobility of the epiglottis also had paresis of the pharyngeal constrictor musculature indicating paresis of the superior laryngeal nerve. Our investigation has shown that patients with paresis of the recurrent nerve who present with dysphagia with or without aspiration should be examined cineradiographically for pharyngolaryngeal function during swallowing.

Swallowing Evaluation in Patients with Unilateral Vocal Fold Immobility

“…The absence of adaptation of UES opening timing to the increase in bolus volume in the patients also suggests the impairment of pharyngeal function, which may also be related to the increase in laryngeal penetration and aspiration [6], and possibly reflects changes in pharyngeal sensitivity or in the control of pharyngeal motor activity. In normal subjects, increases in bolus volume do not cause alteration in pharyngeal transit or clearance, but cause an early onset of anterior laryngeal movement and an early UES opening [9,16,17].…”

“…Limitations in the capacity of the pharynx to generate pressure and in laryngeal excursion affect UES transit. Multiple abnormalities of pharyngeal function were identified in patients with paresis of the recurrent nerve, such as defective closure of the laryngeal vestibule, defective apposition of the corniculate cartilages, defective opposition of the arytenoid cartilages, defective movement of the epiglottis, and paresis of the pharyngeal constrictor musculature when there was also paresis of the superior laryngeal nerve [6]. Some patients with vocal fold immobility had abnormal pharyngeal stripping wave and pharyngeal retention [13], but UES opening impairment was not found in these patients [1,13].…”

“…Abnormalities of supraglottic laryngeal and pharyngeal functions were found in patients with recurrent laryngeal nerve injury and ipsilateral vocal fold immobility [6,7]. An increase in pharyngeal contraction amplitude and reduced pharyngoesophageal wave durations were reported in patients with vocal fold motion impairment [7].…”

“…An increase in pharyngeal contraction amplitude and reduced pharyngoesophageal wave durations were reported in patients with vocal fold motion impairment [7]. If the paresis of the recurrent laryngeal nerve is associated with paresis of the superior laryngeal nerve, there is impairment of the pharyngeal constrictor musculature [6]. Patients with unilateral vocal fold immobility have laryngeal penetration and aspiration with a thin liquid bolus, but it is not frequent with a paste bolus [1,4].…”

Vocal Fold Immobility and Aspiration Status: A Direct Replication Study

“…The relationship among pharyngeal dysphagia, aspiration, and laryngeal functioning is more complex than simply impaired glottic closure during swallowing [19][20][21]. Pharyngeal dysphagia resulting in aspiration will occur only when the pharyngeal swallow is altered enough to prevent efficient bolus passage from the oral cavity through the pharynx and into the esophagus.…”