During a thyroidectomy, a surgeon injures both recurrent laryngeal nerves. Beyond motor weakness of the cords, which additional functional deficit results because these nerves carry sensation below the vocal folds?

• A Loss of taste sensation from the valleculae
• B Impaired laryngeal cough reflex and risk of aspiration ✓
• C Anaesthesia of the pyriform fossae bilaterally
• D Loss of gag reflex mediated through the glossopharyngeal nerve

Explanation

The internal branch of the superior laryngeal nerve supplies mucosa above the vocal folds, while the recurrent laryngeal nerve supplies sensation below them. Bilateral RLN injury therefore denervates the subglottic and infraglottic mucosa, blunting the afferent limb of the laryngeal cough reflex and predisposing to silent aspiration. The pyriform fossa lies above the cords, so option C is wrong, and taste from the valleculae travels with glossopharyngeal fibres.

Reference: Gray's Anatomy for Students, 4th ed.

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