QuestionSBA
QuestionChoice
Incorrect - The external laryngeal nerve innervates the cricothyroid muscle and is at risk during thyroid surgery. It provides mucosal sensation above the vocal folds. Damage to the external laryngeal nerve would cause a reduced range in pitch and a monotonous voice. It would not cause vocal cord palsy, and therefore patients would not present with stridor or breathlessness.
10008302
c
Bilateral damage to the external laryngeal nerve
QuestionChoice
Incorrect - The recurrent laryngeal nerve only supplies its respective signs of the larynx. The right recurrent laryngeal nerve recurs under the right subclavian artery at the apex of the lung. A right recurrent laryngeal nerve injury would therefore cause unilateral vocal fold paralysis, which typically presents as a weak or hoarse voice.
10008301
b
Damage to the right recurrent laryngeal nerve
QuestionChoice
Incorrect - The recurrent laryngeal nerve only supplies its respective side of the larynx. The left recurrent laryngeal nerve recurs under the aortic arch. A left recurrent laryngeal nerve injury would therefore cause unilateral vocal fold paralysis, which typically presents as a weak or hoarse voice. Patients would not immediately present with stridor or breathlessness.
10008303
d
Damage to the left recurrent laryngeal nerve
QuestionChoice
Incorrect - The external laryngeal nerve innervates the cricothyroid muscle and is at risk during thyroid surgery. It provides mucosal sensation above the vocal folds. Damage to the external laryngeal nerve would cause a reduced range in pitch and a monotonous voice. It would not cause vocal cord palsy, and therefore patients would not present with stridor or breathlessness.
10008304
e
Damage to the right external laryngeal nerve
QuestionChoice
Correct - In contrast to unilateral vocal cord paralysis, where hoarseness or shortness of breath may not manifest for days to weeks after the damage has occurred, bilateral vocal cord paralysis usually manifests immediately after extubation. Patients may present with biphasic stridor, respiratory distress, or both, due to dysfunctional vocal cords narrowing and obstructing the airway.
10008300
a
Bilateral damage to the recurrent laryngeal nerve
Concept
Chapter
2693
4661
Hoarseness
Topic
139
Ear, Nose, and Throat
14207
A 34-year-old man underwent a thyroidectomy. Shortly after the procedure, he was noted to be extremely breathless, with an increased respiratory rate and audible stridor.

Which of the following is the most likely underlying pathophysiology?
a