Arnold G E, Stephens C B
Arch Otolaryngol. 1980 Feb;106(2):124-5. doi: 10.1001/archotol.1980.00790260056017.
There are two hypotheses that attempt to explain how a lesion in the lower part of the chest may cause paralysis of both laryngeal nerves with intermediate position of the afflicted cord. The first proposes retrograde degeneration of the vagus nerve up to its nucleus ambiguus, the second, ascending metastasis along the vagus nerve until the superior laryngeal nerve becomes paralyzed. In one case of inoperable lung cancer, the brain-stem was sectioned into a gapless series. The number of cells of the nucleus ambiguus on each side was equal, thus excluding an irreversible retrograde degeneration. However, central chromatolysis was found more than twice as often on the side of laryngeal paralysis. Intermediate vocal cord position was again associated with paralysis of both laryngeal nerves of that side.
有两种假说试图解释胸部下部的病变如何导致双侧喉返神经麻痹以及患侧声带处于中间位。第一种假说认为迷走神经发生逆行性变性直至其疑核；第二种假说认为癌细胞沿迷走神经向上转移，直至喉上神经麻痹。在一例无法手术的肺癌病例中，脑干被切成无间隙的系列切片。两侧疑核的细胞数量相等，因此排除了不可逆的逆行性变性。然而，喉麻痹侧出现中央性染色质溶解的频率是另一侧的两倍多。声带中间位再次与该侧双侧喉神经麻痹相关。
