tag for nbme12, directly helps answer the Q:
Immediately after extubation following a total thyroidectomy, a 72-year-old woman has stridor and shortness of breath. She has a history of transient ischemic attacks and coronary artery disease. Her only medication is aspirin. She appears to be in distress and is gasping for air. Her pulse is 100/min, respirations are 35/min, and blood pressure is 170/100 mm Hg. Examination shows an intact surgical incision and no ecchymosis. Breath sounds are decreased bilaterally. Arterial blood gas analysis on 40% oxygen by face mask shows:
pH 7.3
PCO 60 mm Hg
PO 200 mm Hg
O saturation 99%
Which of the following is the most likely diagnosis?
Laryngeal nerve paralysis
The recurrent laryngeal nerves are responsible for providing the majority of motor innervation to the muscles of the larynx, as well as the sensation to the tissues below the glottis. These nerves course posterior to the thyroid bilaterally, putting them at risk for sustaining injury during a thyroidectomy.