If the recurrent laryngeal nerve were severed on both sides, the vocal cords would assume which position?

If the recurrent laryngeal nerve were severed on both sides, the vocal cords would assume which position?

• A. Be in the open position
• B. Be in the closed position
• C. Be in the intermediate position (2-3 mm apart)
• D. Not be affected unless the superior laryngeal nerve were also injured

Answer: (C)

When both recurrent laryngeal nerves are cut, the intrinsic muscles of the larynx that control opening and closing of the vocal cords are paralyzed. The posterior cricoarytenoid muscles, which are the only muscles that abduct (open) the vocal cords, can no longer function. The main adductors (lateral cricoarytenoid and interarytenoids) are also paralyzed, so there’s no strong force pulling the cords together. The cricothyroid muscle, which is usually intact but does not abduct the cords, tense and lengthen them rather than open or close the glottis. With no muscles actively opening or shutting the vocal cords, the cords settle in a halfway, neutral position—the glottis remains a small gap, typically about 2–3 mm. That’s why the vocal cords would be in an intermediate position. So, the correct understanding is that bilateral RLN injury leaves the cords neither fully open nor fully closed, resulting in a paramedian, intermediate position.

When both recurrent laryngeal nerves are cut, the intrinsic muscles of the larynx that control opening and closing of the vocal cords are paralyzed. The posterior cricoarytenoid muscles, which are the only muscles that abduct (open) the vocal cords, can no longer function. The main adductors (lateral cricoarytenoid and interarytenoids) are also paralyzed, so there’s no strong force pulling the cords together. The cricothyroid muscle, which is usually intact but does not abduct the cords, tense and lengthen them rather than open or close the glottis.

With no muscles actively opening or shutting the vocal cords, the cords settle in a halfway, neutral position—the glottis remains a small gap, typically about 2–3 mm. That’s why the vocal cords would be in an intermediate position.

So, the correct understanding is that bilateral RLN injury leaves the cords neither fully open nor fully closed, resulting in a paramedian, intermediate position.