Correspondence (letter to the editor): “Recurrent Laryngeal Nerve Palsy” Is Not Differentiated Enough

Unfortunately, the authors of this article kept referring to “recurrent laryngeal nerve palsy” in an undifferentiated manner. This “diagnosis” can conceal a minimum of nine different forms of laryngeal palsy, whose treatment and prognosis vary—and this excludes the differential diagnosis of non-surgical and non-neurogenic fixation (1, 3). Whereas neurogenic lesions that include the recurrent nerve (2) are associated with paresis of the affected vocal fold, a similar paresis affects the external branch of the superior laryngeal nerve, in which the vocal folds retain normal mobility. It is presumably for this reason that this variant is often misdiagnosed, although the postoperative voice pathology is highly abnormal (3). Knowledge of this variant without involvement of the recurrent nerve is very important for surgical treatment, because it can—and should—be prevented only by separating the nerve branch before ligating the superior thyroid vasculature; in our own experience neither conservative approaches nor phonosurgery yield substantially better results.