Tactics of obsozhennya and treatment of ailments with paresis or parallel to the larynx of developmental etiology. Rotational laryngeal nerve: symptoms and methods of removal of inflammation and paresis Vocal nerve

Call the throat, sound and cough Infectious diseases ENT organs: tonsilitis, angina, GDVI, otitis media. In general, most people are seen in the first few days, becoming ill, but afterwards, if the sign of adequate treatment subsides and does not become known. fired up ENT organs supravodzhuyutsya zagalny weakness, headache and changes in temperature.

About the neurogenic nature of ailments

At the same time, the significant symptoms are all at once or sometimes they appear rapt and repeat periodically in vigilant attacks, supervising the temperature of the body and zalnym nezduzhannyam, Varto thinks about the neurogenic nature of the phenomenon. Neuralgia diagnosis can be made only when all young somatic diseases are diagnosed with similar symptoms. Tim, who suspects that he has neuralgia, will have to undergo a consultation with an ENT doctor and dentist before being advised by a neuropathologist.

If we are talking about neuralgia, then let's grab the structure of the so-called blukyuyu nerve (div. Malyunok)

1 - dorsal nucleus of the bloating nerve; 2 - the core of a single path; 3 - the nucleus of the spinal cord of the tripartite nerve; 4 - sub-core; 5 - the cranial root of the anterior nerve; 6 - the bloating nerve; 7 - jugular opening; 8 - upper vuzol of the bloody nerve; 9 - lower vuzol of the blukus nerve; 10 - throat of the bloody nerve; 11 - from the full throat of the bloating nerve to the sinus throat of the ovarian nerve; 12 - gulp gossip; 13 - superior laryngeal nerve; 14 - internal throat of the superior laryngeal nerve; 15 - callus of the superior laryngeal nerve; 16 - upper heart throat of the bloating nerve; 17 - lower heart throat of the blukayuyu nerve; 18 - livy rotary laryngeal nerve; 19 - trachea; 20 - ringed ointment; 21 - lower pharyngeal constrictor; 22 - middle pharyngeal constructor; 23 - syropharyngeal ointment; 24 - upper pharyngeal constrictor; 25 - infantile-pharyngeal ointment; 26 - m'yaz, scho pіdnіmaє pіdnebіnnu fіranku, 27 - hearing trumpet; 28 - vushna throat of the bloating nerve; 29 - meningeal throat of the bloating nerve; 30 - ulopharyngeal nerve

Neuralgia of the superior laryngeal nerve

The rotary laryngeal nerve is one of the endovylocks of the bloating nerve (X pair of cranial nerves). Winning sensitivity and control of fast throat muses, soft faintness and ringing mucus of the larynx.

When the rotary throat nerve is severely affected, the pain syndrome is typical for neuralgia: a precarious, even more severe pain in the case of subtle curled zones in the pharynx or the throat. A cold attack is supervised by a dry cough and a severe vegetative symptomatology right up to the loss of symptoms.

Cough, a change in the frequency of the heart is very fast and the damage of the blood is tied with the damage of the blukyuyu nerve. Neuralgia of the rotary throat nerve, the posture of the attack does not supervise the damage of the joint and sound-and-sound. The emergence of a number of symptoms to indicate progress pathological changes and transition of neuralgia to the stage of neuritis.

Neuralgia of the ulcer-pharyngeal nerve

The oxyopharyngeal nerve - the IX pair of cranial nerves, will prevent the sensitivity of the root and the posterior third of the tongue, the mucous membrane of the middle ear and the eustachian tube (a single empty air and pharynx), and the throat of the throat Win also takes care of the part in the innervation of the carotid sinus - an important reflexogenic zone, which grows in the course of the sleepy artery and takes part in the regulation arterial vise and hearty activity.

Neuralgia of the lazykopharyngeal nerve is manifested by attacks typical for the pain of a patient: strong, hectic, attack-like in the area of ​​the base of the language, weakness and dullness, as seen in the air. The oxyopharyngeal nerve lacks the posterior nucleus and is in frequent contact with the bloody nerve, and with this, the vegetative symptoms of the analogous neuralgia of the rotational nerve are detected.

Drum string neuralgia

Drum string to take revenge on the fiber of the face, intermediate. mobile (threefold) і facial nerve. Win over the senses of the middle wuh, hearing trumpets and relish receptors front two third move.

Neuralgia of the drum string (glib neuralgia of an individual) we are sick in the ear canal, which appears in the throat and the roots of the tongue, the attack is often superfluous with mucus and paresthesias in the eyes of the cough in the throat, which provokes a provocation.

The whole syndrome is often of a secondary nature, the causes of the pain can be nerve compression by swelling or expansion as a result of the ignition process in the area of ​​the nipple-like outgrowth and the rocky part of the nerve cyst. In the event of the appearance of similar symptoms, it is necessary to carry out an external rounding up of the procedure. organic cause getting sick.

Neuralgia of the vushny university

Vushnoy vuzol lies down from the middle to the lower slit nerve in the muscle from the empty skull. Krim of the main stovbur of the third head of the three-part dressings from the auricular nerve and the head of the middle meningeal gossip. Winning for a sensitive and vegetative innervating of mussels, pulling on a drum mug, podnebinnu fianca and silky vines.

The main symptom of neuralgia in a higher educational institution is є gostry on the surface shell and in the skinny area. ill-feeling can be widened to the lower slit, the upper third of the sheath and into the area in the aisle... An attack of supernovae to lay the worm and hypersecretion of the silky vines on the affected side.

The neuralgia of the vushny university chronically fired in pre-colonic anatomical structures: glottis, migdaleas, sinuses and teeth and cysts of the lower slit.

Neuralgia of the submandibular and submandibular university

Piddle vuzol lie down until the same time sloppy vines, Roztashovanoy pіd m'yazy і mucous membrane of the bottom of the empty company. Vin of the formations of the sensitive tongues of the ovarian nerve, vegetative ones - of the drum strings and the pretty gossip of the callous sleepy artery.

In case of neuralgia of the submandibular university, post-life is considered bad b_l in the widespread area, as soon as I will attack, I will make a quick start and become baking. The triviality of an attack is from a few hilin until one day, at the same time, it is also overwhelmingly dreamy, or dryness in the mouth. Symptoms of the neuralgia of the pediatric university are similar to those described, the attack is provoked by the transfer.

Laryngeal nerve: structural and functional features

The statistic will indicate that there is also a rotary nerve, such as its function, signs of its development and discomfort, which is supervised by its dysfunction.

The laryngeal nerve plays an important role in the life of the skin people, as it is the innervation of the larynx, the beruchs share their own fate in sound production. Distant special features.

Trochi about anatomy

Laryngeal nerve є gilkoyu X bet of cranial nerves. Win revenge in both clothes and sensitive fibers. Name yomu - a bloody nerve, which gives a glimpse of the heart, larynx and voice apparatus of the recipients, as well as to the visceral organisms.

The name "turning" will characterize the yogo movement in the body of people by going from the cranium. From the skin side of the shia there is one throat of the bloating nerve, but the route is similar. Tsіkavo, shho viyšovshi from the emptying of the skull, the rotary nerve from the spatula to the breast cancer, De, bypassing the great arteries, opening the loop around them, and only then turning into the shia, to the larynx.

For people, such a route can be glued-free, since before turning to the larynx, it’s not a function. As a matter of fact, the whole nerve is the finest proof of the people’s eulogy (more lecture - in the video).

It turned out that the ribs of Danes nervіnervuyut three remaining wagons, passing before them in the form of wintry arteries. Such a route is very natural and very short for them. In the course of the revolution, a shia appeared among the workers, which had been earlier in the ribs, and only great razmiri had appeared.

The Danish factor accepting a boost to the same number of nerves and nerves, and the appearance, at first glance, of illogical routes. You can, take the centimeters of the loop of this nerve in people, do not seem to be of functional significance, but rather represent great value for the scholars.

Uwaga! So the yak itself in people of Denmark has a nerve to run over a dozen centimeters, in a giraffe the same nerve breaks down to take in chotiri metri.

functional significance

There are more motor fibers in the warehouse of the rotary nerve, to go to the laryngeal mucosa, so that the voice-assisting function is not provided; Dani gilki will prevent the innervations of mucous and mucous membranes from the trachea, the trachea is visible.

The upper and lower laryngeal nerves are good for the nerve energy of the heart. Sensitive and parasympathetic fibers enter the warehouse.

key value

Particularly the significance of this nerve is seen in the visualization of the function.

If you can also say:

1. Intraoperative nerve reduction. In this particular type, the most important surgical involvement in the thyroid and parathyroid glands, as well as the vascular bundle. The closeness of the topographic growth of these organs of the internal secretion and the larynx of the laryngeal nerves is brought to an increased risk of development.
2. Malicious process. Cutting a nerve on the thigh with a stretch of metastases, or with a swollen puffiness in the process of growth, can be found, for example, with cancer of the larynx, or thyroid gland.
3. Sertseva pathology. Deyakі vices, which are supervised by significant changes in the chambers of the heart in size, especially the anterior heart, can be the cause of such a pathology, like a parallel laryngeal nerve. Until such heart defects are known Fallot's tetrad, an important mitral stenosis.
4. infectious process... In this vipadku there is a lack of neuralgia of the superior laryngeal nerve, or neuritis. Naybilsh is often ethiological є virus.
5. What are the reasons for the mechanical failure?... Before such a hematoma, she was pretending to be injured, as well as an igniting infiltration in the region. Hypertrophy or hyperplasia of the thyroid tissue is a common cause, especially in endemic regions due to iodine deficiency.

symptomatology

Parallich of the rotary throat nerve has a number of signs:

• the disruption of the dysfunctional function of the winery due to the lack of dexterity of the same or both of the vocal folds, dikhalnyh nobles on vіdnoshennyu to the needs of people;
• hoarseness, as I can show my mother's feet;
• sonorous in vidstani vidh;
• Afonya (can be found as a legacy of a two-way process).

All criterias can be described as “symptom of the rotary throat nerve” to the understanding.

In such a rank, with paresis of the laryngeal nerve, all three functions of the larynx are affected - dyshal, sound-forming and hysterical. The price of the voice is the most visible when it is lost.

Important! A parallel larynx with a folding camp, which is one of the reasons for the stenosis of the upper dichal paths through the rudimentary function of the larynx in the viglyad, the collapse of any of the more daily muzzles.

Retrievely anamnesis of life and ailment with a doctor, allow the suspicion correct diagnosis... It is important for officials from the biography to respect the beasts in consultation with a doctor, and help them with their own hands to establish an accurate diagnosis:

• were carried out the last hour or earlier prompt engagement on the organs of the shia (it is possible, there is little loss of the laryngeal nerve during operations on the shia);
• symptoms appear;
• see you pathology on the side of the heart-vascular system, the presence of noises in the heart, earlier established by the doctor;
• Symptoms that may lead to an oncological process of the larynx - blistering, irradiation in vuho, discomfort in case of discomfort up to dysphagia, etc.

diagnostics

Since I have already seen the food, I will take almost 80% of the information about the medicine when the diagnosis is made from the experience of the patient, the history of life. For example, Lyudin, it’s a good hour at the factory of varnish-and-paint materials.

With the presence of inspiratory dysfunction (accelerated response to inhalation) and hoarseness, an important diagnostic procedure is laryngoscopy. With the help of this, you can play the most powerful voices and enlighten the voice lines, and the newly established area, as such may be the best way to go.

In addition to the visualization of a non-lumbar vocal ring in a unilateral process, there is a dysfunction on the side of the dysfunction - there is a paresis of the left rotary laryngeal nerve, or the right one.

For the confirmation of the cause of vicorisation, such methods as CT, MRI. Dodatkovy methods of further diagnosis add to the clarification of the anterior diagnosis of the process, the growth of which accelerates the development of the bloody or rotary throat nerve.

Uwaga! If the patient has little importance in the steps of mental disability, there is a need for a therapeutic treatment of such a sick person, and if the situation is normal in the future.

for more differential diagnostics vikoristovuyut radiography of the organs of the breast in two projections and laboratory dosage- Clinical and biochemical analysis of blood at the first stage. Paresis of the throaty laryngeal nerve and treatment given to the state of the immune system for all possible reasons.

methods of treatment

Madly, by the first rule effective therapyє ethiotropic treatment, that is, it is directly specific to pathology, in the case of pathogenetic treatment. Vignettes become such stanis, such as double-sided paresis of the rotary laryngeal nerve and removal of which it is necessary to press mittuvo.

I will clutter up the life and the health of the patient is always in need of uncomfortable events. Frequently, when there are symptoms in a hostile dysfunctional deficiency, it can be indicated conservatively paresis of the rotary laryngeal nerves during the previous strummectomy. Ale і in this vypadku finish everything individually.

Lіkuvannya paresis paresis of the rotary laryngeal nerves and the prognosis is due to the fact that paresis is timid or permanent. Antibacterial therapy is indicated for a large number of patients with time dysfunction of these nerves. wide range and glucocorticoids in small doses.

Important! Instructions prior to the date of preparation will tell you about possible indications before the date of receipt. Read obov'yazkovo її.

At the visnovka, it is important to say how the raptus hoarseness appears in the voice of the head of the change. One of the reasons may be a banal varicose pharyngitis, or a minor symptom may be an early sign of an important process.

Nevralgіya verhnegortannogo nerve proyavlyaєtsya strongly pulsuyuchimi, bolіsnimi odnostoronnіmi abo dvostoronnіmi prіtstupoobraznimі (paroxysmal) pain, trivayuchimi protyagom dekіlkoh seconds i lokalіzovanimi in oblastі gortanі (zazvichay on rіvnі verhnoї Chastain thyroid cartilage abo pіd'yazikovoї kіstki) i kuta nizhnoї schelepi, of referred to an eye, vuha, breast tissue and overload and supervise with booze, hypersalivation, cough; neuralgia will do it in the middle of the hour, do not buy analgesics. Provocative factors of neurological sprains are kovtannya, priyom їzhі, posture, cough, syakannya, collapse of the head. Curkovi zones do not appear. Most paroxysms are most often suppressed severe cough, Zagalnoyu weak, often uncomfortable camp. On the surface of the sheath, the viscera of the thyroid cartilage (the place where the laryngeal nerve passes through the thyroid membrane), a point appears to be ailing.

There are methods of eliminating new blockades, alcoholization of the upper laryngeal nerve in the zone of the hypothyroid membrane; also effective carbamazepin (or finlepsin). In resistant vipads, it protrudes to the nerve overflow.

The jovial cause of the neuralgia of the superior laryngeal nerve є the suppression of the inner thigh when it passes through the pituitary membrane. Likewise, thanks to the tribute to Z.Kh. Shafiev and Kh.A. Alimetova (Department of Otorhinolaryngology, Kazan State Medical University), one of the causes of neuropathy of the superior laryngeal nerve, osteochondrosis. Pathological impulses in cases of osteochondrosis of the spine ridge segments (PDS) form in the zones of the innervations of the symptom complex of myoforms, when they turn in the pressure of the fast muscles, the belts, gills physiological camp.

We assigned the disease by the authors of a boule of obesity and proliferation of 28 ailments with neuropathy of the superior laryngeal nerve from 32 to 76 years. The triviality of the disease became from 5 to 22 years. For a whole hour, the stench consulted and consulted with the young people (endocrinologist, neuropathologist, otorhinolaryngologist, therapist, psychiatrist and in.), Often unsuccessfully, and because they knew the "own" doctor. The ineffectiveness of the carried out treatment was the reason for the development of a secondary neurosis in them right up to the hospitalization in the neuropsychiatric hospital. Assurance included examination of the pharynx and larynx, palpation of organs and mucous membranes, X-ray and electromyography, consultation of a neurologist. With endopharyngeal digital dosage, in 4 ailments, a sore cord was revealed on the rivni of the papillary cyst in the projection of the synovial and posterior thymus of the digastric mucosa. With indirect laryngoscopy, in all 28 ailments, a ringing of pear-like colonies was observed on the sides of the laryngoscopy and the appearance of the half of the larynx before the hour of the flash. Sign of burning in the throat and larynx did not bulge. Palpation in all the ailments showed a rapid pituitary appearance on the side of the neuropathy of the superior laryngeal nerve. Pid'yazikov's hand at a time took a spit of the position, but turned to the side, yak, I will win over the painful impulses from the defeated PDS. In 10 ailments, the most common point was in the projection of the upper horn of the thyroid cartilage, in others - to the posterior, in the hypopodiacal region. Electromyography from the stagnation of superficial (nashkirny) electrodes confirmed the change in the tone of the anterior laryngeal and laryngeal mucosa by 2-2.5 times in proportion to the norm. Radiological preliminaries also confirmed the presence of osteochondrosis shyny viddilu ridge. The variability of clinical manifestations of osteochondrosis did not depend on the prevalence of radiological symptoms in the PDS. on cleverly show sickness more poured in the feet of the clenched nerve stubs at the entrance from the mid-ridgeline openings and the ignition vines near them. The patient was diagnosed as having secondary neuropathy of the superior laryngeal nerve for lingering osteochondrosis. The pathogenesis of neuropathy of the superior laryngeal nerve, imovirno, develops in 2 moments: 1 - compression of the nerve in the muscle of the passage of the larynx through the thyroid membrane; 2 - obmezhenya nerve in the gap between the upper edge of the thyroid cartilage and pid'yazikova cyst.

The treatment plan included sedative therapy, massage of the shiino-comic zone, postisometric relaxation (PIR) of the anterior laryngeal larynx and thyroid membrane, new blockade and punctuate analgesia of sickly grievous muscles. During the 8-10 PIR sessions, the ailment got sick, 17 ailments had a local blister, and the reshti had a change. After 1 ric, 2 ailments already had a painful character, while the rest of the patients had a remission of trivial from 2 to 5 rocks.

Analyzes of the intestinal pathology have come to visnovka, as well as osteochondrosis of the tavernous ridge and vyklikana, asymmetric shiina myazo-fascial pathology can be the cause of neuropathy of the superior laryngeal nerve, which can be taken by x-ray methods.

Rotational nerve neuralgia

MKX-10 code: G52.2

Neuralgia of the superior laryngeal nerve- one of the local syndromes of headache and facial pain, tied to lesions of one nerve, such as, for example, neuralgia of a triple abnormal nerve.

a) Symptoms and neuralgia class of the superior laryngeal nerve... Epizodic prickly bile, slug one-sided, irradiated in the upper part of the thyroid cartilage, cut of the lower slit and bottom part wuha. When there is an onslaught on the larynx, ailments appear in the area of ​​the great horn of the laryngeal cyst, or the thyroid membrane.

b) Reasons and mechanisms of development... The reason for the neuralgia is unclear, it may be linked to a virus infection, a previous trauma (or surgical operation) For a nerve injury tied to the anatomical features of the given area (for example, pid'yazikova kistki).

Inspiration is spontaneous among individuals in the 40-70 years of age. The trigger zone grows in a pear-shaped colony and fights when it is blown, when it’s growing for an hour, when it coughs.

v) Lіkuvannya neuralgia of the superior laryngeal nerve... For the treatment of neuralgia, repeat blockade of the superior laryngeal nerve. rozchin muscle anesthetic inject into the space between the great horn of the cyst and the upper horn of the thyroid cartilage. Dopomagaє also use carbamazepin.

Butt with tanistropheus graft, Dr. Sc. Yuriy Viktorovich Tchaikovsky at his monograph "Science about the development of life".
Win nav yogo in the quality of the illustration:
1. Biological underestimation.
2. The ability of a successful vision all over the manifestation of a new biologically underestimated sign.

There is about the vicopian lizard (tanistropheus), the remains of one that dates back to the middle of the three-year period.
Tanistropheus is the essence of the creature found in the history of the Earth. I especially primitive here are those who are great - nasty bent, Oskilki in the wide area of ​​all 9 (or 10) ridges.
As a result, tanistropheus will be so "A deck on nizhkah":

For the sake, for example, the significant number of aquatic plesiosaurs is also known as bullets. Ale stench and "suprovodzhuvalisya" - a great number of ridges. Yak minimum, three dozen. And for the deyas it was up to 70 times. The same number of ridges made the plesiosaurs beautifully nimble (melodiously).
Axis, for example, the skeleton of Elasmosaurus:


He himself has a record number of ridges (more than 70).

At the connection with cym, vineyard nutrition is a more beautiful product than that of tanistropheus:
1. The product of the evolution in the course natural species?
2. For the product of the evolution in circulation the opposite natural species?
3. What about product design (within the framework of the concept of versatility to the design of new biological taxons)?

Apparently, there is an African giraffe that is just like "tanistropheus" today on Earth.
At my glance, there is one of the most beautiful satellites of the Earth:

Unimportant to those with a giraffe (with the smallest ridges) but slightly shorter, lower in the vicopian tanistropheus, the giraffe has a serious complex of specific biological problems that are bred to the very same child. І special "engineering solutions", such as problems and problems.

For example, the problem of blood circulation (I quote from the video):
A high level of growth is improved for the blood circulation system, especially for the brain. This heart is especially strong in giraffes. There is a pass of 60 liters of blood in khilina, 12 kg is important and I open a vice, which is three times higher than that of a human. Tim is no less, it could not have been blamed for being overwhelmed with a sharp lowering and raising of the giraffe's head. In order for such a ruch not to wake the death of a creature, the roof of a giraffe is thick and very much more than a human being. Besides, the giraffe has a special hold of the valves in the great shiyny vein, and the blood is soaked in such a rank, so that the grip of the head artery is retained, so that the brain is supplied.

And the axis is so giraffe of snakes piti :)

P.s. Singingly, the best marvel at the unique design of a giraffe - creativity (oskilki є cranks of a smart idea in the most modern biological taxa). The stench often produces a giraffe in the quality of the most intelligent design, and not the evolution in the course of natural (or anti-natural?) Vidboriv.
For zats_kavlenikh - science-popular posilannya on tsyu topic.

Defeat the rotary nerve wiklikє to reach the type of laryngeal disease - so called whistling breath, or parallel larynx (Hemiplegia lаringis).

Ailments are often found in horses, older in great horned thinness, and even more rarely in dogs.

Castroans are sick most often (71%), more sickly horses (20%) and cats (8-10%). In most cases, there are ailments from 3 to 6 years, older than more old.

As a rule (close to 95%), there is a lack of pivotal nerve and, as a rule, a lack of parallax (hemiplegia). Bilateral parallax of the rotary nerves is called diplegia.

The rotary nerve passes in the area of ​​the cranial laryngeal nerve opening and in the stubbling of the bloating nerve, emerging from the thoracic emptying. Livy rotary nerve flicker і backward of the aortic arch, switch to її right surface And the right hand is right-handed and the back of the key artery. Along the lower surface of the trachea, the carotid artery, the pivotal nerve goes into the vortex right up to the larynx, de і enter the cricoid-thyroid (mucous membrane, nasal in the new, under the name of the caudal laryngeal nerve (A.F. Klimov).

Ethiology... The post-infectious nature of the ailment is precisely established. Clinical suspicion is connected to the direct connection of the rotational nerve parallels in the absence of ailments to mitoma, chronic infectious bronchitis and angina, breeding ailments, and fluences.

Established the value of toxins in the diagnosed degenerative changes in the bloating nerve and the thymus.

Significant key interest is to present the knowledge of the role of aneurysms of the aortic arch, which heals the trunk of the rotational nerve. In such vipads, the pivotal nerve becomes flat against the grip of the wall of the continuously pulsating aorta.

The number of nerve bundles in the nerve is changed, the stovbur is dense, siruvato-red color, and it is not possible to pull on the right one, since there are more folds and weak (Lurs).

The role of recessive nagging in the development of parallels is not sufficiently understood. However, vvazhayut, scho wono maє more importantі maє vrahovuvatisya in horse breeding. Those who authorize the ability to see the hemiplegia and diplegia of the larynx as a history of family pathology (Weiss, 1937; Sheper, 1939).

The breed also plays a role in the diagnosis of ailments. The Belgian licar Navi (1940) revealed that atrophy of the laryngeal mucosa in carriages was observed in 50% of cases, in purebred and half-blooded English horses in 12.5% ​​and in other generations only 6.5%.

Є caution of the practitioners about the detection of parallaxes of the rotational nerve on the ground of the thyroid gall, and moreover, the vicious thyroid gall took the lump, wanting a small amount of swelling (Dornis). Vermeulen and іnshі of 24 fledged horses fought only three, the chotiers had a deyak polіpshennya and 17 trivins were not worn out.

Indirect causes of substitution and obstruction of the vocal nerve, both from the left and from the right side there may be some improvement lymphatic universities in the aperture of the thoracic clitini and at the aorta and trachea bubble, enlargements of the stravochids, abscesses in the area of ​​shia and in.

Pathogenesis. The pathological process can develop in a different way. Take it off, fend it off in the center of the bloating nerve as a result of the detachment, fend off the ruff nuclei dovzhastogo brain... So, as the rotary nerve folds out of the sensitive and ruff fibers, then in the cob, the cocked period of the ailment, it is gradually promoted to increase the sensitivity of the effector fibers, as a result of which it quickly develops in parallel with the bitterness. On the cob of ailment, the function of mucous membranes, which expands the larynx, is used, so that the sound of stenosis appears when inhaling. If the function of all the mucous membranes is increased, it will be nervous with the rotary nerve (behind the vignette of the cyclone-thyroid). As the rotary nerve paralyzes, then the innervations of the muscles are absolutely paralyzed, and it is especially important that the loss of the arytenoid cartilage becomes uncomfortable. When you inhale, it will go down (west) into the empty larynx, and if you are drunk, hitting on the cartilage, you will get a loud noise from the vigil's whistle or wheeze.

With atrophy and degeneration of the rotary nerve, as a result of the collapse of the aortic arch aneurysm, the mechanism of the pathological process of the polyagus in the offensive. Rozlad of the innervations of the larynx is indicated in front of the change of the vocal ring on the side of the affected nerve. The stink is melting and ignorant (mlyaviy paralich), and then vzagal active roc to cuddle up, after a lot of scooped cartilage, tightening up the scaly omentum with a force, and when inhaling, it’s going to vocalize at once into the larynx enlightenment and a bi-valve. When you see, as a result of a weakening of the tone of the vocal ring, and the child's (morganian) gut grows in touch, and then, in its own heart, it takes even more significant sound of the vocal ring in the midst of the bitter winter. at the young creature.

The sound of the larynx during inhalation, which is also due to the contraction of the protracted vocal ring and the general mutilation, can be easily accommodated when the Russian creature is hardened. With bilateral nerve damage, the strus noise reaches the greatest world.

Often the lesion of the left nerve stovbur will explain to him that he himself is facing the back of the aortic arch, and right along the path of the clavicle artery.

Vazhayut, how fired up and degeneration of the tim, how the pivotal nerve flexes on the aortic point in such a way that as a result of strong pulsation with fast gaits, in a step-by-step shrinking, developing ischemia and ignition process in nerve fibers (Martin, 1932). Continuously reducing the nerve along the aortic point of the wikipedia from the connection of this heat, and then to the degeneration and parallel. In the thoracic part of the rotary nerve and in the right nerve stovbur, the descriptions were not known (Thomassen, 1941).

pathohistological dosage showed significant changes in the larynx. The stench of a blonde color, conglomeration and atrophy, especially on the denervated side. Asymmetry of the larynx and vitality of the rotary nerve appear.

In case of histological preliminaries of nerves that have grown close to the aortic arch, degenerative-atrophic changes in the surrounding fibers are revealed. Such degeneration of nerve fibers can be found in the zone of the nerve adhesion to the aortic arch, which should be explained by the manifestations of Wallerian degeneration.

When wheezing, rooted as a result of the withdrawal, it is not only the pivotal nerve that is hostile, but the motor heads of the facial, okorukhovy and secondary nerves (IV pair). Vermeulene immediately spasmed the facial nerve paralysis, ptosis and ulceration of the nasal opening on the sides of the collapse. Cutting off the left rotary nerve wicks the sound of the vocal slit, which supervises the hoarseness and broken lights, ale whistling noises from the outside. With a bilateral lesion in the midst of both cartilages and vocal cords, there is wheezing (Yu. N. Davidov).

Yaksho parallichi vinikli as a result of the destruction of the creature infectious ailment Then signs of stenosis of the larynx develop in 5-6 months and more if it is ailment. When weakened by chinoy (laterism), we found degeneration of ganglionic clitins in the ventral horns spinal cord and nuclei of the bloating nerve. In addition, atrophy of nerve fibers, growth of the stroma of the nerve and the appearance of intermittent infiltration showed up as ailments.

key picture... Characteristic noise of stenosis of the larynx, clearly sensitive only before the hour of the creature. On the cob of the ruch, make no noise, don't feel the least bit, the scab is dull. Proceeding from an extra hour I start to wheeze or a loud noise. Win over to your satisfaction and reach according to the height and tone of the maximum possible. To that, in the Nimetsky literature, the ailment was called Reren, which means surmit. At high gaits, whistling and wheezing noises will cope with and so much speed up in breath that the creature can fall into.

Developing і suppurative appearances: cyanosis of mucous membranes, "fiery zholob", emphіzema legenіv.

One hour, with the noise of stenosis in horses, there is an inspiratory backlash due to significant enlargements of the nasal openings and breast cells with a stepwise development sign of breath. If you want to make a little bit of food, you should crumple up, and after 3-5 minutes, it will be normal for you. Vip drops are periodically detected with a throaty whistle.

In case of unilateral damage, there is a weakening of one kind of vocal ring (part of the voice), as when inhaling, it is strongly tightened in the middle of the larynx. The voice width is asymmetric, so as half of the left is left, the scooped cartilage is hanging. The apex of the epiglottis is replaced in to the left side The configuration of the entrance to the larynx is changed. The operation of the communication stan is updated.

With bilateral parallax of the pivotal nerves, the vocal slit becomes slit-like; If, in the normal voice, the ligaments symmetrically change their shape when inhaled and vidikhu, then the side is easily paralyzed by the change in the shape of the vocal ligament and arytenoid cartilage.

In a dog, double-sided parallich is characterized by a ringing of the vocal line and three-way vocal ringing when inhaled (Grazl, 1939).

forecast... In neglected patients, the prognosis is unpleasant, since nerve damage is regenerated, degenerative-atrophic manifestations of laryngeal mucosa occur less and less and there is a change in the formation of normal ventilation. With postinfectious parallels in horses (mitii, influenza), the hardening is possible in 2-3 months. Parallichi larynx, which rose from the creatures, ailments to the plague, sometimes become aware of this.

Toxic damage to the rotary nerve, which is caused by the loss of a fellowship (lateism), is rarely caused by the disease, often the symptoms of laryngostenosis are due to the weakness of the course of the disease. It is possible to increase the frequency of the heart as quickly as possible to tie the lesions of the nuclei of the blukyuyu nerve.

diagnosis... Diagnosis of a laryngeal ailment is possible Laryngoscopic to preliminaries, or by looking around in other animals, the Rinolaryngoscope can be inserted along the lower course, visually entered into the larynx and according to the growth of cartilage patches and the characteristics of voices. L. Tarasevich recommending koristuvatisya 20 mm gum pipe. Її enter into the trachea along the lower nasal passage. It is normal for the scooped cartilages to grow out, and when the smell is inhaled, the stench wiggles and the tube is pressed. At the same time, you can feel characteristic clattering sounds. As soon as the larynx is abused, it is not difficult to see it only.

It is important to be given to correct when palpating the larynx. Pressing your finger on the lions of the scooped cartilage and fixing the larynx with a protylny hand, you can feel stenosing noises when inhaling. Well, if you hit the right scooped cartilage at once, then you can see the screeching of the voice slit and the signs of smell.

In practice, it is often given to diagnose hemiplegia of the larynx by the diagnosis of an inspiratory laryngeal whistle, which can be used when the horse's collapse is accelerated.

In differential treatment, there is stenosis of the upper side of the nose region, and there is a whistling noise during inhalation. In addition, the ringing of the nasal passages can cause a polyp and swelling of the nasal passages.

Timchasov signs of stenosis of the larynx may be vicious catarrhal inflammation of the larynx, nodules, pharyngitis. It is easy to see if there is an anamnesis, according to the rapid development and significant ailment during palpation of the larynx.

lykuvannya... Expansions of the operational method of conversion, proponation in 1865 by K. Gunther and reinforced by Williams (1906) and Eberlein (1912). The technique of the operation is described in detail by I. І. Magda in a handbook "Operative surgery of domestic creatures" (1963). Meta operational vision side slingshot In that, it is possible to establish at the micro-operation of the granulation of tissue, transforming into a scar, a sound fiches to the voice at the inner laryngeal wall, in order to prevent the blight. The most important effect on the part of both children. In order to improve the strength of the extirpation, it is recommended that the catgut sound the voice from the edge of the mucous membrane of the extirpated vocal intestine (I. I. Magda).

The operation is effective in 75% of creatures. However, there are horses (25%), but sometimes they are not very large intestines, and it is often possible to explain the negative results, which make the operation easier (BM olives).

You may relapse stenosis. The stench picks up at the sound of the sound, the scarring tissue on the muscle of the thorny bicep duck will attract the sound of a healthy voice to itself. I didn’t bother, I would recommend to see the middle part of both voices at once from the viewers, for this purpose it would be desirable for the hopeful and new ones (Coco, 1939).

S. V. Ivanov (1954, 1967) changed the technique of operation. Primed on the fact that Vilyams' obvious ways, Eberlein will overcome the great trauma of the larynx in the mountain, so that the ring-tracheal ligament and the first tracheal ring will cross over, and also need to take the form of trachea, and rhombic plate of thyroid cartilage. Dissection of the lateral laryngeal intestine is carried out with a blunt walk behind the aid of two lapchases. Kishenka vivodyat in the end of the virus and see or feed. The wound is powdered with streptocide, and sewing is applied on the edge. Do not shy away from the tracheotomy. Access to the larynx is through the middle opening of the tissue in the larynx area. Sickness Mistseve. The larynx is not happy with the path of blocking the cranial laryngeal nerve with a 2% rate of change. Tsei method of transformations on 30 horses with an experimental rosette of the rotational nerve і, following the author's caution, can be overwhelmed before other methods.

In case of ailments, if you allow for the potential for regeneration of the rotational nerve, we recommend using vitamin B1 (aneurin) and B 12 (cobalamin). The creature needs to be able to act as a robot. Winikak not bezopeka odor can be squeezed to the curvature of one nizdri, and in some cases, tracheotomy.

Methods of neuroplasticity have been promoted with the help of the brain stem for the renewal of the rotational nerve regeneration; Thus, McDonald and інші Author performed the implantation of the peripheral stubbore of the paralyzed rotational nerve in horses into the blukuyu nerve. When you see Tag, in chotiroh vypadki from five it is possible to blame for nothing. Seraphin and Ufreduts transformed the conversion of the peripheral stovbur of the rotary nerve in the dog into the bloody nerve, as well as the ligamentous nerve.

Yaksho vi knew the mercy, be weasel, see a fragment of the text and natisnit Ctrl + Enter.

MKX-10 code: G52.2

On the sides of the nerve strikes, all internal (vlasy) larynx appear paralyzed. As well as the ringing ring, innervated by the ringing of the superior laryngeal nerve, the activity becomes active, the folds are stretched into the paramedian of the position.

If there is an incomplete parallels in paresis, one should introduce voice folds(The posterior cricoid muzzle) I make stripes in the picture. Qia is one- or two-sided form of paresis vіdoma yak paresis of the back myasis (posticus paresis). In case of sparing ailments with a parallel of vocal folds, it is also possible to use the stroboscopic method. If in the process of caution there is a colony of mucous membrane, then we can talk about the cob of renewal of the function of the affected nerve, like є with a friendly prognostic acquaintance.

Unilateral paresis of the rotational nerve

a) Symptoms and clinics... A cut of the rotational nerve is often diagnosed in a vague way and manifests itself in the hospitable phase of the same or important dysphonia. The voice is often updated. Serious signs of obstruction of dyshally nobles are called out on the day, when they are deprived of an important physical assignment. Patients can’t take high notes or move their voice.

b) diagnostics... With laryngoscopy, a fold appears to a deaf voice, which is located in the Paramedian or lateral position on one boat. For the establishment of the cause of the injury, it is necessary to have an additional Laryngoscopic, phoniatric, neurological and radiological dosage.

v) lykuvannya... As soon as it became ill, it became the reason for the paralysis of the vocal fold, not to lead to the renewal of the function, to carry out voice therapy, in order to update the voice folds for the prevention of activation of one side of the fold bots.

Bilateral paresis of the vocal nerve

a) Symptoms and clinics:
Dyspnoea and the threat of asphyxia through the sound of the voice line. With physical activity, sleep for an hour or so, the strus stridor appears.
Dysphonia appears, as I grow tricky - from 4 to 8 years. in the deposition of the causes of damage to the vertebral nerves. Let the voice grow weak and hoarse. Mova is digested in trivial inspiratory phases.
characteristic symptomє also weakly coughing.

b) Reasons and mechanisms of development presented in the tables below.

v) diagnostics... Diagnosis primed on the results of laryngoscopy. With a bilateral lesion of the rotary throat nerve, the voices fold into the Paramedian position.

G) Lіkuvannya bilateral paralysis of the vertebral nerves:

The renewal of the normal flow of dyshally nobles is of the highest importance. Before the tracheotomy and the inserted cannula with a rose valve, it is removed in case of important dyspnea, so that if the maximum is visible, the reach is less than 40% of the normal for the given patient. Bagatom ailing physical navantazhennya, In the calm, the stench is inviting to cope with the dyspnea.

Although spontaneous remission is not present, surgical enlargement of the epiglottis is shown. Yogo can be visited in 10-12 m / s. when the picture appears paresis. Before the operation, they are quietly ill, for those who are constantly dyspnea and are surrounded physical activity If a tracheostomy is applied to the patient, the patient would like to shake off the rose valve. Hirurgicheskiy korektsiyu recommend to visit the path of the private aritenoidectomy and rear chordectomy.

principle of operation... The operation is performed endoscopically behind the aid of a CO2 laser. A part of the vocal ridge of the mensh of the arytenoid cartilage, where the obstruction of the lumen of the lower ring-shaped ring is removed, is resected (a part of the artenoidectomy) and the elastic cone is raised on the entire length of the protuberance. rosіkayut back part the vocal folds are resected by a part of the vocal mucosa (posterior chordectomy).

bottom part lining mucous membrane Place the larynx laterally on the bottom of the larynx (morgan) and fold the front. The shaping of the vocal fold in the back of the vocal fold and the preservation of the front of the vocal fold allows you to preserve the contact of the vocal folds and the power of the flash.

P.S. It’s better to keep pace with the back view of the voice line of the operation, because it’s better to introduce phonation.

order s surgical entitlements Correction of the defect is carried out by moving the way to renew the voice on the equal voice line or the folds of the front.

Pislyaoperative collapse of the collapse of the vocal folds (it is composed of a voice muzzle, a vocal ring and a curved mucous membrane) є "water stone" of surgical thyroidology. The frequency of such a dreadful slowdown is due to the fact that I want to think about it, and, on the thought of bagatokh fakhivtsiv, is greatly underestimated. A large number of rotary laryngeal nerves (a kind of achilles p'yata in thyroid surgery [SH]) is not diagnosed by surgery intraoperatively, and if classic paintings... In fact, it is not necessary to confirm the data of literature, in which the frequency of the additional acceleration (reduction of the rotary laryngeal nerves) is significant 0.2 to 15%.

On the basis of the authors' opinion, the frequency of the rotary throat nerve is found in a straight line due to the nature of the thyroid gland. Obviously, the value of the upper limit of the norms for a great operation, for example, for the drive of the cancer of the SHZ, is significant. However, the growth of operational activity among non-oncological ailments and as a result of the increase in the number of accelerated ones cannot but become turbulent. The most risky in the plan of the described acceleration (reduction of the rotary laryngeal nerves) nodular goiter... So, the parallel larynx during the primary operation with good thyroid disease is diagnosed in 05 - 3% of the ailments, in the malignant - in 5 - 9%, and in the case of recurrent goiter - in 11% of the ailments and more. The collapse of the collapse of the vocal folds for thyroid dectomy appears in 1.1 - 4.3% of the warning, for the subtotal resection - in 0.6 - 3%, for the hemithyroid dectomy - in 0.2 - 1.4% of the warning. І, so, the topography of the laryngeal nerves is clear, as (topography) is of great importance for the surgeon, as well as the proximity of the expansion of the laryngeal nerves to the thyroid

The larynx is nervous with the upper and rotary laryngeal nerves (nervus laryngeus superior, nervus laryngeus recurrens), which come out of the bloating nerve (nervus vagus) and may be in its warehouse, sensitive and parasympathetic fibers.

Superior laryngeal nerve Win from the bloody nerve, go down and before, behind the internal sleepy artery right up to the larynx. The food of the bifurcation of the extravagant sleepy artery (in the middle 4 cm) is distributed over two bottles:

1 ... the inner throat of the superior laryngeal nerve (VVVGN) is seen transversely along the nipple fascia, at the same time the upper laryngeal artery perforates the inner throat of the thyroid membrane and spreads in the larynx; VVVGN revenge sensitive and parasympathetic fibers, innervate the mucous membrane of the epiglottis, the root of the tongue and the larynx, the vocal folds; the whole nerve also carries fibers of savoring sensitivity from the epiglottis and parasympathetic fibers for the mucous membranes;

2 ... zovnishnya galuza of the superior laryngeal nerve (NVVGN) descend down into the dorsolateral directly from the sleepy arteries, then overflowing, passing behind the upper thyroid artery, reaching the larynx; NVVGN - rukhova, іnnervu m'yazi-constrictor of the pharynx and ring-shaped m'yaz; the topographic position of the NVVGN to the upper thyroid artery and the upper pole of the ShchZ is a key moment in the operation; In Danish hour, 4 types of such errors are seen: 1) NVVGN overshoots the upper thyroid artery at the top of the wall more than 2 cm from the upper pole (42 - 62%), 2) NVVGN overshoots the upper thyroid artery at the top of the 27 cm - less than 2 cm %), 3) NVVGN does not overflow the upper thyroid artery or the thighs of the lower upper pole (13 - 14%), 4) NVVGN does not overflow the upper thyroid artery, but the suprathyroid artery up to the drop of the 13th pole to the other 7 %); beast for myself I respect the fact that with a great goiter, such a variant will be developed in 56% of cases.

Rotary laryngeal nerve(VMN) to revenge sensitive, robotic and parasympathetic fibers; I will take care of the innervation of all the mucous membranes of the larynx, except for the ringlet, as well as the sensitive innervation of the mucous membrane of the larynx below the vocal folds. The pivotal laryngeal nerve on the right enters from the bloating nerve on the ryvnii peretin from the clavicular artery, the mallet - from the arch of the aorta. Distant evil, bending around the aortic arch in lig. arteriosum, and the right-handed person - on the clutch artery, goes up the hill, between the airway and the trachea, right-handed in 64%, evil in 77%. Zliva VMN pass as medially as possible, right-handed - lateral and obliquely. At the level of the ShchZ, the posture of the fascial sheath, the VMN goes up the hill, pass through the sound of Berry, or in the її tovschі, under the hump Zuckerkandl, or maybe there are appearances with the medial appearance of the remaining blue (humpback). parts of the ShchZ, appear from the inner side). In 40% of cases, there is a prevention of nerve proliferation for bringing and introducing the laryngeal mucosa can be expelled out of the larynx, for example, in the Berry junction (the shchZ junction). The offense of the VMN on its own way is to overtake the lower thyroid arteries, passing in front, behind it, or intertwining with it. Described are 30 options for mutual growth, protects the head of the VMN appear in decile milimeters from the lower thyroid artery in the area of ​​the Berry ligament. Zliva VMN beckon to pass behind the lower thyroid artery, right-handed - often in advance or intertwine with it.

At the present time of the bagatories (P.S. is older, O.Yu. Karpova, K.N. Chilingaridi, M.B.Salib), the bulo was installed, so that the collapse of both vocal folds was destroyed, as a result of the operation on the ShchZ, you can not only to two-sided upper bounds of norms, but also to unilateral small-to-one-sided steps in a strong or bypassing reflex spasm of the vocal fold on the prototype fight. There can be a picture of a bilateral parallel to the larynx.

At the presentation of the complex provision(Skarg, anamnesis, laboratory and instrumental data) all the manifestation of the upper bounds of norms can be changed by the next rank :

1 . unilateral parallel larynx: There is hoarseness, stupidity in the voice, sluggishness when growing, feeling uncomfortable with growing phrases, choking when you are getting sick, especially when growing, seeing outside body in the throat, innocent dry cough;

2 . bilateral parallel larynx with diagnoses of true bilateral stenosis At any given time, there is a lack of text (visualization of the tube of the sound of the larynx or the trachea), there is a lack of difficulty in dealing with it;

3 . I will have bilateral stenosis of the larynx as a result of: 1) unilateral distress of the upper inter-norms and the diagnosis of severe reflex spasm of the vocal fold on the protylnyh botsi - when extubation helps to reduce the burden of distress, Afstony, and unhappiness 2) unilateral reduction of the upper limits of the norm and the diagnosis of the last reflex spasm of the vocal fold on the protolezhny botsi - when Afonya appears, slightly complicating the dysfunction, as well as choking on the occasional perioral spasm of the spasm

The diagnosis of a persistent reflex spasm of the vocal fold can also be caused by a decrease in the level of ionized calcium in the blood (it appears in all ailments with a pathological thyroid gland, with a drive which was carried out operatively, without a reason, without The diagnosis of the past reflex spasm of the vocal fold can be a hyperventilation manifestation in individuals with labial nervous system, And also hyperventilation before an hour of anesthesia in the day after the decrease in the amount of calcium in the blood

The situation is welcome, if there is an operation in the area of ​​only one part of the ShchZ in during the operational period the collapse of the collapse of both vocal folds appears. From the current positions, the price can be explained by the offensive rank: on the side of the operation, there was a partial injury of the upper boundary norms, and on the protolezhny boat, there was a reflex spasm of the vocal fold, which was augmented by a frequent overlapping of the nerves of the throat.