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Recurrent laryngeal nerve

 

 
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Recurrent laryngeal nerve
 
 
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The recurrent (inferior) laryngeal nerve is a branch of the vagus nerve (tenth cranial nerve) that supplies motor function and sensation to the larynx
Larynx

The larynx , colloquially known as the voicebox, is an organ in the neck of mammals involved in protection of the vertebrate trachea and sound production....
 (voice box). It travels within the endoneurial sheath. It is the nerve of the 6th Branchial Arch
Branchial arch

In the embryogenesis of vertebrate, the pharyngeal arches are anlage for a multitude of structures. They develop during the fourth and fifth week in utero as a series of germ layer#Mesoderm outpouchings on the left and right sides of the developing pharynx....
.

s referred to as "recurrent" because the branches of the nerve innervate the laryngeal muscles
Larynx

The larynx , colloquially known as the voicebox, is an organ in the neck of mammals involved in protection of the vertebrate trachea and sound production....
 in the neck through a rather circuitous route: they descend into the thorax
Thorax

The thorax is a division of an animal's body that lies between the head and the abdomen.In mammals, the thorax is the region of the body formed by the sternum, the thoracic vertebrae and the ribs....
 before rising up between the trachea and esophagus to reach the neck.

The left laryngeal nerve branches from the Vagus [X] nerve to loop under and around the arch of the aorta (ligamentum arteriosum) before ascending, whereas the right branch loops around the right subclavian artery.

The nerve splits into anterior and posterior rami before supplying muscles in the voice box — it supplies all laryngeal muscle
MUSCLE

MUSCLE is public domain, multiple sequence alignment software for protein and nucleotide sequences.MUSCLE is integrated into UGENE bioinformatics tool as a plugin....
s except for the cricothyroid
Cricothyroid muscle

The cricothyroid muscle attaches to the anterolateral aspect of the cricoid and the inferior cornu and lower lamina of the thyroid cartilage, tilting the thyroid forwards and tensing the vocal cords....
, which is innervated by the external branch of the superior laryngeal nerve
Superior laryngeal nerve

The superior laryngeal nerve is a branch of the vagus nerve. It arises from the middle of the ganglion nodosum and in its course receives a branch from the superior cervical ganglion of the sympathetic....
.

The recurrent laryngeal nerve enters the pharynx, along with the inferior laryngeal artery, below the inferior constrictor muscle.

nerve is best known for its importance in thyroid
Thyroid

The thyroid is one of the largest endocrine glands in the body. This gland is found in the neck inferior to the thyroid cartilage and at approximately the same level as the cricoid cartilage....
 surgery, as it runs immediately posterior to this gland.






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The recurrent (inferior) laryngeal nerve is a branch of the vagus nerve (tenth cranial nerve) that supplies motor function and sensation to the larynx
Larynx

The larynx , colloquially known as the voicebox, is an organ in the neck of mammals involved in protection of the vertebrate trachea and sound production....
 (voice box). It travels within the endoneurial sheath. It is the nerve of the 6th Branchial Arch
Branchial arch

In the embryogenesis of vertebrate, the pharyngeal arches are anlage for a multitude of structures. They develop during the fourth and fifth week in utero as a series of germ layer#Mesoderm outpouchings on the left and right sides of the developing pharynx....
.

Path

It is referred to as "recurrent" because the branches of the nerve innervate the laryngeal muscles
Larynx

The larynx , colloquially known as the voicebox, is an organ in the neck of mammals involved in protection of the vertebrate trachea and sound production....
 in the neck through a rather circuitous route: they descend into the thorax
Thorax

The thorax is a division of an animal's body that lies between the head and the abdomen.In mammals, the thorax is the region of the body formed by the sternum, the thoracic vertebrae and the ribs....
 before rising up between the trachea and esophagus to reach the neck.

The left laryngeal nerve branches from the Vagus [X] nerve to loop under and around the arch of the aorta (ligamentum arteriosum) before ascending, whereas the right branch loops around the right subclavian artery.

The nerve splits into anterior and posterior rami before supplying muscles in the voice box — it supplies all laryngeal muscle
MUSCLE

MUSCLE is public domain, multiple sequence alignment software for protein and nucleotide sequences.MUSCLE is integrated into UGENE bioinformatics tool as a plugin....
s except for the cricothyroid
Cricothyroid muscle

The cricothyroid muscle attaches to the anterolateral aspect of the cricoid and the inferior cornu and lower lamina of the thyroid cartilage, tilting the thyroid forwards and tensing the vocal cords....
, which is innervated by the external branch of the superior laryngeal nerve
Superior laryngeal nerve

The superior laryngeal nerve is a branch of the vagus nerve. It arises from the middle of the ganglion nodosum and in its course receives a branch from the superior cervical ganglion of the sympathetic....
.

The recurrent laryngeal nerve enters the pharynx, along with the inferior laryngeal artery, below the inferior constrictor muscle.

Clinical significance

The nerve is best known for its importance in thyroid
Thyroid

The thyroid is one of the largest endocrine glands in the body. This gland is found in the neck inferior to the thyroid cartilage and at approximately the same level as the cricoid cartilage....
 surgery, as it runs immediately posterior to this gland. If it is damaged during surgery, the patient will have a hoarse voice. Nerve damage can be assessed by laryngoscopy, during which a stroboscopic
Stroboscope

A stroboscope, also known as a strobe, is an instrument used to make a cyclically moving object appear to be slow-moving, or stationary. The principle is used for the study of Rotation, Reciprocation, oscillation or vibration objects....
 light confirms the absence of movement in the affected side of the vocal cords.

Similar problems may also be due to invasion of the nerve by a tumor
Tumor

A tumor or tumour is the name for a swelling or lesion formed by an abnormal growth of cells . Tumor is not synonymous with cancer. A tumor can be Benign neoplasm, Carcinoma in situ or malignant, whereas cancer is by definition malignant....
 or after trauma
Physical trauma

Physical trauma refers to a body injury. A trauma patient is someone who has suffered serious and life-threatening physical injury with the potential for secondary complications such as Shock , respiratory failure and death....
 to the neck. A common scenario is paralysis of the left vocal cord due to malignant tumour in the mediastinum affecting the left branch of the recurrent laryngeal nerve. The left cord returns to midline where it stays.
  • If the damage is unilateral, the patient may present with voice changes including hoarseness.
  • Bilateral nerve damage can result in breathing difficulties and aphonia
    Aphonia

    Aphonia is the medical term for the inability to speak. It is considered more severe than dysphonia. A primary cause of aphonia is bilateral disruption of the recurrent laryngeal nerve, which supplies nearly all the muscles in the larynx....
    , the inability to speak.
  • The right recurrent laryngeal nerve is more susceptible to damage during thyroid surgery due to its relatively medial location.


History

Galen
Galen

Aelius Galenus or Claudius Galenus , better known as Galen of Pergamum , was a prominent Ancient Rome physician and philosopher of Greek origin, and probably the most accomplished medical researcher of the Roman period....
 is said to have first described the clinical syndrome of recurrent laryngeal nerve paralysis.

Veterinary medicine

In Veterinary medicine, 'roars' refers to a deficit in the left recurrent laryngeal nerve causing characteristic stertorous
Stertorous

Medically used word expresses respiration characterized by a heavy snoring or gasping sound, i.e hoarsely breathingIt occurs in common with mouth breathing due to chronic nasal obstruction...
 sounds upon inspiration.

It is treatable by specialists in equine medicine.

Additional images


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