Radiography Chest Chest radiography is not sufficient for the complete evaluation of thoracic causes that can contribute to vocal cord paralysis. Chest CT is more sensitive, particularly for detecting aortopulmonary window and paratracheal lesions [168]. Radiography can only reveal large lesions in the lung apex or mediastinum that may cause CN X deficits but fails to detect small clinically relevant lesions or pathology in the aortopulmonary window and the paratracheal region that can contribute to vocal cord paralysis [158,168]. US Neck US is not able to fully image the entire course of CN X in the posterior fossa or the recurrent laryngeal nerve extending into the upper thorax, both of which can be simultaneously imaged with contrast-enhanced neck CT extended through the AP window [157,158]. US is a complementary modality that can be used to guide biopsies of lesions in the neck that contribute to a CN X palsy [158]. Transcutaneous laryngeal US is an innovative, noninvasive technique that may be suitable to directly assess vocal cord movement in select patients at high risk for iatrogenic vocal cord palsy following surgery or intubation [169-174]. Variant 7: Unilateral isolated weakness or paralysis of the sternocleidomastoid and trapezius muscles (accessory nerve, CN XI). Initial imaging. The accessory nerve (CN XI) consists of a small cranial root originating from the nucleus ambiguous within the medulla oblongata and a large spinal root originating from the ventral horn of the spinal cord, between the C1 and C5 levels. The two components join and enter the pars vascularis of the jugular foramen [2]. The accessory nerve supplies portions of the sternocleidomastoid muscle and the upper portion of the trapezius muscle. Accessory nerve palsy is clinically manifested by weakness and atrophy of these muscles, causing decreased shoulder abduction, shoulder pain, cosmetic disfiguration, and disability.
Cranial Neuropathy. Radiography Chest Chest radiography is not sufficient for the complete evaluation of thoracic causes that can contribute to vocal cord paralysis. Chest CT is more sensitive, particularly for detecting aortopulmonary window and paratracheal lesions [168]. Radiography can only reveal large lesions in the lung apex or mediastinum that may cause CN X deficits but fails to detect small clinically relevant lesions or pathology in the aortopulmonary window and the paratracheal region that can contribute to vocal cord paralysis [158,168]. US Neck US is not able to fully image the entire course of CN X in the posterior fossa or the recurrent laryngeal nerve extending into the upper thorax, both of which can be simultaneously imaged with contrast-enhanced neck CT extended through the AP window [157,158]. US is a complementary modality that can be used to guide biopsies of lesions in the neck that contribute to a CN X palsy [158]. Transcutaneous laryngeal US is an innovative, noninvasive technique that may be suitable to directly assess vocal cord movement in select patients at high risk for iatrogenic vocal cord palsy following surgery or intubation [169-174]. Variant 7: Unilateral isolated weakness or paralysis of the sternocleidomastoid and trapezius muscles (accessory nerve, CN XI). Initial imaging. The accessory nerve (CN XI) consists of a small cranial root originating from the nucleus ambiguous within the medulla oblongata and a large spinal root originating from the ventral horn of the spinal cord, between the C1 and C5 levels. The two components join and enter the pars vascularis of the jugular foramen [2]. The accessory nerve supplies portions of the sternocleidomastoid muscle and the upper portion of the trapezius muscle. Accessory nerve palsy is clinically manifested by weakness and atrophy of these muscles, causing decreased shoulder abduction, shoulder pain, cosmetic disfiguration, and disability.