Post-traumatic superior laryngeal neuralgia

Several years after tonsillectomy-or more quickly after foreign-body trauma-the superior laryngeal nerve may be so bound by fibrosis that any regional inflammation or further local trauma, aggravated by normal laryngeal movements, can give rise to localized neuritis at the thyrohyoid membrane and cause a characteristic pain. In every one of 21 patients observed in the past five years, a point of tenderness was readily found by digital palpation over the lateral portion of the thyrohyoid membrane or over the superior cornu of the thyroid cartilage. Frequently the pain extended into the throat and became worse as anything was swallowed past this point. Medical therapy alone or with external injection followed by five minutes of local massage relieved the pain in most cases. It seems possible that, in a more recalcitrant case, relief could be obtained by incising the thyrohyoid membrane so as to relax the superior laryngeal nerve.