Recurrent laryngeal nerve paralysis: Current concepts and treatment: Part I-phylogenesis and physiology

Abstract

The aim of this review article is to summarize current concepts in unilateral recurrent laryngeal nerve paralysis (URLNP). Important aspects of laryngeal phylogenesis, physiology, and anatomy are reviewed. Recent advances in the neurophysiology of URLNP are discussed. Revised and updated principles of diagnosis and treatment are provided. Glottic configuration and prognosis vary according to the type of neural lesion (neurapraxia, axonotmesis, or neurotmesis). Therapeutic indications depend on glottic configuration and prognosis. Treatment options include medialization thyroplasty, vocal fold augmentation by injection, arytenoid adduction, and laryngeal reinnervation. Each treatment option is summarized, and the results reported in the medical literature are reviewed.