Anatomy & Histology · patient case question
Her hoarseness of voice suggests involvement of which nerve?
Patient case: Persistent lower lip lesion
Patient: Female, 44 years old
Chief complaint: “There's a small lump on my lower lip that hasn't gone away.”
History: Reports occasional hoarseness of the voice over the past two months. No systemic disease.
Findings: A small, firm, well-defined nodule on the labial mucosa of the lower lip, present for more than five months and unchanged in size.
Show answer and explanation
Correct answer: A. Recurrent laryngeal nerve
- A. CORRECT. The RECURRENT LARYNGEAL NERVE, a branch of the vagus, supplies all the intrinsic laryngeal muscles except cricothyroid. Damage paralyses the vocal cord on that side, producing HOARSENESS. Its long, vulnerable course explains the clinical pattern: the left nerve loops under the aortic arch, so left-sided hoarseness may signal an aortic aneurysm, a mediastinal mass, or lung cancer, while both nerves are at risk in thyroid surgery.
- B. The hypoglossal nerve is motor to the tongue. Injury causes deviation of the protruded tongue TOWARD the damaged side, with wasting and fasciculation — speech is slurred, not hoarse.
- C. The EXTERNAL branch of the superior laryngeal nerve supplies cricothyroid, the vocal cord tensor. Injury weakens the high register and causes voice FATIGUE rather than frank hoarseness — a career-ending injury for a singer but a subtler finding.
- D. The glossopharyngeal nerve supplies sensation and taste to the posterior third of the tongue, the oropharynx, and motor supply to stylopharyngeus. Injury causes swallowing difficulty and loss of the gag reflex, not hoarseness.
Note: Persistent unexplained hoarseness lasting more than two to three weeks warrants ENT referral. It is a recognised warning sign for laryngeal and lung malignancy.
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