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Neuroradiology

E1173. Where Did Your Voice Go? An Anatomic and Radiologic Review of Unilateral Vocal Cord Paralysis

Ball J,  Blanchard A,  Gupta J,  Gupta N. Tulane School of Medicine, New Orleans, LA

Address correspondence to J. Ball (jball3@tulane.edu)

Background Information: Vocal cord paralysis (VCP) can be a devastating condition that can impair one’s ability to communicate with others and can make breathing difficult and laborious. VCP is a well-known complication of surgeries involving the neck such as thyroidectomy and carotid endarterectomy. As a result, patients are monitored for common presenting symptoms of VCP after such surgeries, including dyspnea, hoarseness, and dysphonia. Other etiologies of VCP include trauma, infection, inflammation, and mass infiltration or compression. Up to 20% of cases of unilateral VCP are idiopathic.

Educational Goals/Teaching Points: The aims of this presentation are to review the anatomy and innervation of the larynx, particularly that of the glottis and vocal folds, and demonstrate the pathologic mechanisms by which unilateral vocal cord paralysis can occur. Appropriate imaging techniques will be discussed. Uncommon and common cases from our institution will be shared.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques: The right and left vocal cords are each innervated by respective recurrent laryngeal nerves, which are branches of the vagus nerves. Various pathologies can interfere with the neural pathways involved in vocal cord function. Depending on expected course of the offending cause, specific focused imaging protocols are preferred. CT is preferred for evaluating the lower course of the vagus nerve. CT and MR evaluation of the mid-neck and larynx complement one another, while MRI is preferred for the upper course of the vagus nerve including the skull base.

Conclusion: VCP and its clinical sequela can significantly impair a patient’s quality of life. Prompt and accurate identification of the cause is essential for treatment. An in-depth understanding of the anatomy, pathophysiology, imaging findings, and differential diagnoses of VCP can enhance the radiologist’s diagnostic accuracy and influence subsequent clinical management.