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The Right Recurrent Laryngeal Nerve
Transcript of The Right Recurrent Laryngeal Nerve
The recurrent laryngeal nerve has two sections: the right and the left (Ardito, Revelli, D’Alartia, Lerro, Lavinia, & Ardito, 2004).
It is a myelinated nerve (Fleming, Gibbins, Harries, & Ingram, 2011).
The RRLN is approximately 6cm long (Balasubramanian, 2006).
The RRLN ascends between the trachea and the esophagus (Seikel et al., 2010).
It travels under and behind the right subclavian artery (Seikel et al., 2010)
The Normal Anatomy of the Right Recurrent Laryngeal Nerve (RRLN).
Case 4: Damage to the Right Recurrent Laryngeal Nerve resulting from Thoracic Outlet Syndrome (TOS) Surgery.
The Normal Function of the Right Recurrent Laryngeal Nerve (RRLN)
The RRLN plays a crucial role in ensuring the proper working order of the Larynx (Yau, Verma, 2013).
The RRLN innervates all muscles within the right side of the Larynx except the Cricothyroid muscle (Yau, Verma, 2013).
The RRLN plays a major role in adduction and abduction of the vocal folds (Washington Voice Consortium, 2003).
The RRLN innervates mucosa below the vocal folds (General Practice Notebook, 2013)
Image 1. Recurrent laryngeal nerve. From "Studyblue" by Delisio, A., 2013, http://www.studyblue.com/notes/note/n/annie-endo-week-5/deck/5405088.
Anatomy of a Damaged Right Recurrent Laryngeal Nerve
Adductor: Lateral Cricoarytenoid (LCA)
Abduction: Posterior Cricoarytenoid (PCA)
Tensor: Thyrovocalis (TV)
−Muscles still active
Cricothyroid – innovated by the Superior Laryngeal Nerve
Interaryntenoid – bilateral innervation from the left RLN
−Sensory Pathway effected
Right sub-glottal region
− Positioning of damaged vocal fold
Adducted – weak interaryntenoid muscle
Tensed – unopposed cricothyroid
(Atkinson, M & McHanwell, S., 2002)
Increase in size of inactive muscles
Changes to Normal Phonation due to Right Recurrent Laryngeal Nerve Damage
Damage to the right recurrent laryngeal nerve causes changes to normal phonation as a result of unilateral paralysis to the vocal fold, in this case the right vocal fold (Benumof, & Hagberg, 2007).
Craig Daniels may be experiencing changes in his voice including;
limited pitch range (Reddy, S., 2004).
Figure 2: Right lateral view of the superior and recurrent laryngeal nerves. From "Laryngeal nerve anatomy" by Yau, A, 2013 http://emedicine.medscape.com/article/1923100-overview
Figure 4. One-sided Vocal Fold Paralysis. From "Vocal fold Paralysis; Understanding the Disorder" by Washington Voice Consortium, 2003, http://www.voiceproblem.org/disorders/paresis/understanding.php#
Figure 5. Vocal Cord Problems. From "Vocal Cord Polyps, Nodules, and Granulomas" by The Merck Manual Home Health Handbook, 2013, http://www.merckmanuals.com/home/ear_nose_and_throat_disorders/mouth_and_throat_disorders/vocal_cord_polyps_nodules_and_granulomas.html
Jess Wall - S00142999
Mikaeka Uebergang- S00153357
Lisa Gore - S00153075
Alice Keith - S00154179
(The Voice Doc, 2011)
The Function of the Right Recurrent Laryngeal Nerve in Normal Phonation
Phonation occurs as a result of the passive interaction between the vocal folds and the exhaled airstream, causing vibration and therefore the physical act of speech (Seikel et al., 2010).
The RRLN enables normal phonation by innervating the muscles seen on the previous image which adduct, abduct and change the tension of the vocal folds.
Figure 3: Intrinsic muscles of the larynx. From "Normal Anatomy" by University Muhammadiyah Malang, 2010, http://bedahunmuh.files.wordpress.com/2010/05/intrinsic-muscles-of-larynx.jpg
Ardito, G., Revelli, L., D’Alartia, L., Lerro, V., Lavinia, M., & Ardito, F. (2004). Revisited anatomy of the recurrent laryngeal nerves. The American Journal of Surgery, 187, 249-253.
Atkinson, M., & McHanwell, S. (2002). Basic medical science for speech & language therapy students. London, England: Whurr Publishers.
Balasubramanian, T. (2006). Applied anatomy of recurrent laryngeal nerve. Retrieved from http://www.drtbalu.com/app_anarecner.html
Benumof, J., & Hagberg, C. A. (2007). Benumof's airway management: Principles and practice (3rd ed.). Retrieved from http://books.google.com.au/
Delisio, A. (2013). Studyblue [digital image]. Retrieved from http://www.studyblue.com/notes/note/n/annie-endo-week-5/deck/5405088
Fleming, J.C., Gibbins, N., Harries, M., & Ingram, P.J. (2011). An anatomical study of the myelination of human laryngeal nerves. The Journal of Laryngology & Otology, 125, 1263-1267. Doi: 10.1017/s0022215111001939
General Practice Notebook. (2013). Recurrent laryngeal nerve. Retrieved from http://www.gpnotebook.co.uk/simplepage.cfm?ID=369492028&linkID=28953&cook=yes.
Hixon, T., Weismer, G., & Hoit, J. (2008). Preclinical speech science: Anatomy, physiology, acoustics, perception. San Diego, CA: Plural Publishing.
Merck Manual Home Health Handbook. (2013) Vocal Cord Polyps, Nodules, and Granulomas [Digital Image]. Retrieved from http://www.merckmanuals.com/home/ear_nose_and_throat_disorders/mouth_and_throat_disorders/vocal_cord_polyps_nodules_and_granulomas.html
National Spasmodic Dysphonia Association. (2013) Anatomy of Voice. Retrieved from http://www.dysphonia.org/anatomy.php
University Muhammadiyah Malang. (2010). Normal Anatomy [Digital Image]. Retrieved from http://bedahunmuh.files.wordpress.com/2010/05/intrinsic-muscles-of-larynx.jpg
Reddy, S. (2004). Vocal cord paralysis and vocal cord medialization. Retrieved from http://www.utmb.edu/otoref/grnds/vocal-cord-040428/vocal-cord-040428.htm
Seikel, J.A., King, D.W., & Drumwright, D.G. (2010). Anatomy and physiology for speech, language and hearing (4th ed.). Clifton Park, N.Y.: Delmar Cengage Learning.
The Voice Doc. (2011, October 11). Right Vocal Fold Paralysis [Video file]. Retrieved from
Washington Voice Consortium. (2003) Vocal fold Paralysis; Understanding the Disorder. Retrieved From http://www.voiceproblem.org/disorders/paresis/understanding.php#
Washington Voice Consortium. (2003) Vocal fold Paralysis; Understanding the Disorder [Digital Image]. Retrieved From http://www.voiceproblem.org/disorders/paresis/understanding.php#
Yau, A. (2013). Laryngeal nerve anatomy [digital image]. Retrieved from http://emedicine.medscape.com/article/1923100-overview