Altered voice due to vocal cord palsy may be the only manifestation of an underlying serious medical condition. Malignancy (especially lung cancer) and iatrogenic trauma (following thyroid surgery) are the most common causes. The longer intrathoracic course of left recurrent laryngeal nerve (RLN) makes it vulnerable to involvement by numerous conditions mainly of mediastinal origin. Vocal cord palsy due to RLN involvement by mediastinal lymphadenopathy of benign and inflammatory aetiologies is uncommon, but includes pulmonary tuberculosis. Involvement of RLN in mediastinal disease is rare. We describe such a case of mediastinal tuberculous lymphadenitis presenting as right vocal cord palsy diagnosed by computed tomography scan. A-24 years-old female presented with acute history of hoarseness of voice and right neck swelling. Indirect laryngoscopy revealed paramedian position of right true vocal cord. CECT chest confirmed the mediastinal lymphadenopathy. Supraclavicular lymph node cytology came positive for Mycobacterium tuberculosis on CBNAAT. Patient was started on category 1 anti tubercular treatment and is on follow up. 

Orofacial granulomatosis is a chronic relapsing-remitting inflammatory condition that shares a similar phenotypic presentation to some other granulomatous diseases as Crohn’s disease. Various etiological agents such as food additives, dental materials, and various microbiological agents have been implicated in the disease process, its precise pathogenesis is yet to be elucidated. Delayed type of hypersensitivity reaction appears to play a significant role. The aim of this article is to report a case of OFG with its clinical presentation, and etiology. It also projects the challenges that a professional has to face in the diagnosis and treatment planning of such cases.