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The function of the muscles of the larynx can suffer with various infections, injuries, overexertion of the voice, congenital weakness (Fig. 4.16).

In the first place among myogenic paralysis is paralysis of the internal vocal muscle, the folds do not close during phonation, an oval gap remains between them, which often happens with acute laryngitis. In case of damage to the lateral cricoid-scyphoid muscle, the anterior two-thirds of the glottis do not close, it looks like an irregular rhombus, and with paralysis of the intercranial muscles they do not close in the back third of the glottis in the form of a triangle. In case of damage to the posterior vocal muscle, which is the only expander of the glottis, the vocal fold is stationary in the middle, the glottis expands only due to the opposite muscle. Aspirated, the glottis looks like a rectangular triangle. Voice formation and breathing, however, are not disturbed. Another thing is with bilateral paralysis of these muscles, when a tracheotomy is required with the threat of asphyxiation. However, myogenic paralysis of these muscles - the dilators of the glottis - is very rare, usually due to damage to the recurrent nerve, the only one that innervates this muscle, in contrast to muscles - constrictors that have cross-innervation.

The main causes of lesions of the recurrent (lower throat) nerve are aortic pathology, cardiac muscle hypertrophy, mediastinal tumors. More often, the left recurrent nerve is affected, passing along the mediastinum much lower than the right, to the level of the aortic arch. Finally, 2.5-3% of stumectomies performed by surgeons is accompanied by a unilateral, less often bilateral lesion of the recurrent nerve. In case of unilateral lesion of the nerve, the fold is first located in the midline, then there is compensation of the respiratory function due to the restructuring of the tone of the constrictors and the lateral shift of the affected fold by one third of the lumen (the so-called cadaveric position). A healthy fold goes away during phonation beyond the middle (sagittal) line, the arytenoid cartilage lies behind the paralyzed.

Unilateral damage does not require treatment. With a bilateral lesion, a tracheostomy is usually applied, and then a larynx operation is performed with the removal of one or two folds to eliminate stenosis (chorectomy).
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