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Vocal Fold Paralysis. Three areas where damage can occur:Brainstem NucleiCorticobulbar fibers start from the cerebral cortex and descend through the internal capsule and synapse at the nucleus ambiguus in the MedullaVagus NerveRecurrent Laryngeal Nerve. NOTES: When assessing this, remember that this all a continuum with upper motor neurons and lower motor neurons. The key here is being able to differentiate between the entire vagus nerve being damaged which will also changes superior to the 9459
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