Recurrent laryngeal nerve paralysis

Heralded by breathy voice, hoarseness, or aspiration. Refer to ENT for endoscopy to determine if vocal cord is paralyzed and its position.

4 possible positions: 1) median, 2) paramedian, 3) intermediate, 4) lateral (cadaveric).

Many patients can compensate for median or paramedian position. Patients requiring intervention are usually treated with medialization techniques, either

1) injection,

or 2) medialization thyroplasty using an implant. For injections, different materials may be selected for desired duration of effect. Early intervention may be employed with temporary materials. If no spontaneous recovery after 1 year, injection with Teflon is essentially permanent