Head and Neck Imaging

Recurrent laryngeal nerve palsy

The main symptom of recurrent laryngeal nerve palsy is hoarseness. The offending lesion may be on the course of the recurrent laryngeal nerve (distal vagal neuropathy), or more proximal on the course of the vagal nerve (proximal vagal neuropathy).

The imaging features of vocal cord paralysis are atrophy of the thyroarytenoid muscle (the muscle of the true vocal cord), anteromedial deviation of the arytenoid cartilage, enlargement of the ipsilateral laryngeal ventricle and pyriform sinus, and a paramedian position of the vocal cord. Apart from signs related to vocal cord paralysis, palsy of the recurrent laryngeal nerve also leads to atrophy of the commonly innervated posterior cricoarytenoid muscle (Fig.1).

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Fig.1

a-c. Axial contrast-enhanced CT images of larynx in patient with left side vocal cord paralysis. Ipsilateral relative dilatation of pyriform sinus (arrow, a) and laryngeal ventricle (arrow, b) are seen. The left arytenoid is slightly anteromedially displaced (arrowhead, b). Atrophy of the left posterior cricoarytenoid muscle (arrow, c); compare with normal right cricoarytenoid muscle (arrowhead, c).
Recurrent laryngeal nerve palsy, Fig.1 (a)
Recurrent laryngeal nerve palsy, Fig.1 (b)
Recurrent laryngeal nerve palsy, Fig.1 (c)