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Laryngeal CT revealed anterior displacement of the left arytenoid cartilage (arrowhead), obliteration of cricoarytenoid joint space, and the arcshaped left vocal cord (arrow).
Source publication
Conclusion: Closed reduction is effective and safe for the treatment of arytenoid dislocation, and the selection of an appropriate time window to perform closed reduction is crucial in achieving relatively stable treatment outcomes and short treatment duration.
Objective: The aim of this study was to investigate whether there is an appropriate time...
Citations
... For patients with a posterior AD, the arytenoid cartilage was in the posterior position, the vocal fold on the affected side was longer than that on the unaffected side, and the glottis demonstrated a long triangular shape 11 ; (c) the laryngeal computerized tomography (CT) scan found disparities in the heights of the vocal folds as well as the angles of the glottis between the affected and unaffected sides, partial or complete separation of the arytenoid cartilage and the cricoid cartilage, and that the joint space was enlarged ( Figure 2. Ideally, it is desirable to present CT images at several levels of consecutive sequences. Our CT layer spacing was 0.5 mm and we were not able to include clear, multi-layer images illustrating an entire cricoarytenoid joint in this article) 12 ; and (d) the patient's symptom of hoarseness had significantly improved after the closed reduction of AD with topical anesthesia and video laryngoscopy ( Figure 1C,D). 13 F I G U R E 1 Video laryngoscopy images showing arytenoid dislocation (A,B) and vocal folds after closed reduction of arytenoid dislocation (C,D) ...
... 20 The inconsistent left and right arytenoid cartilage densities in the same patient will also blur the 3D reconstructed image, or the incompleteness in the scanning image of the arytenoid cartilage may affect the diagnosis. 12 It has been reported that laryngeal electromyography (EMG) is vital for differentiating AD and vocal fold paralysis. However, laryngeal EMS has not been widely used in clinical practice because of its difficulty and invasiveness and the relatively high diagnostic rate. ...
... Furthermore, during the insertion of an NG tube, if the patient experiences nausea and choking, the distal end of the NG tube may directly touch or hurt the arytenoid cartilage, causing its displacement. 2,12 This study found that 45 of the 49 patients had both NG tube and EI for general anesthesia; 20 were intubated with the NG tube first, followed by the EI. We speculate that an existing NG tube may limit the movement of one side of the cricoarytenoid joint. ...
Objective
Arytenoid dislocation (AD) after general anesthesia with endotracheal intubation (EI) is an iatrogenic injury that impairs patient function and requires reduction. We aimed to investigate the risk factors of AD following EI.
Methods
This retrospective case‐control study involved surgical adults who received EI for general anesthesia at a single institution from June 2010 to June 2020. Cases included all the patients who had AD. We used a ratio of 1:5 to identify patients in the propensity‐matched control group.
Results
Multivariate analysis of 49 cases with AD and 245 controls without AD demonstrated that the use of a nasogastric (NG) tube (odds ratio [OR], 23.9; 95% confidence interval [CI], 6.8–84.1), undergoing abdominal surgery (OR, 3.7; 95% CI, 1.2–11.9), and an operative time longer than 3 h (OR, 5.2; 95% CI, 2.1–12.9) were risk factors for AD. We did not find significant independent associations between AD and 40 years or older age, gender, body mass index, whether a laryngeal mask airway was used, endotracheal tube size, and EI performers' experience.
Conclusion
The use of an NG tube, abdominal surgery, and longer operative time were risk factors for AD. Among these, the NG tube application showed a strong association with AD. Preventive measures of informing the patients of the increased risk and providing high‐level patient monitoring can reduce the incidence of AD.
Level of Evidence
III
... The full-text screening of such articles led to exclusion of 46 studies that did not match inclusion criteria. The remaining 20 articles [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] (471 AS/AD cases in total) were considered eligible for entering our analysis. In Figure 1 we summarized the selection process. ...
... Skoretz et al. [28] systematically reviewed the literature about dysphagia after intubation and reported an incidence that ranged from 3 to 62%, but as for dysphonia, this symptom solved within the first week. Only Lou et al. [13] and Zheng et al. [20] investigated dysdipsia (difficulty in swallowing liquids) in the clinical evaluation of AS/AD and found it in 88.6% and 74.2% of their patients, respectively. ...
... In seven out of 20 case series, questionnaires were used for subjective evaluation of voice in AS/AD patients. Six groups used the Voice Handicap Index (VHI) questionnaire that was validated to quantify the psycho-social consequences of voice disorders [7,8,12,13,19,20]. VHI is characterized by three domains regarding functional, physical, and emotional aspects of dysphonia-related handicap. ...
PurposeTo review the current management of arytenoid subluxation/dislocation (AS/AD) focusing on diagnostic, therapeutic, and prognostic controversies.Methods
The international literature of the last 20 years has been considered. After the application of inclusion criteria, 20 studies were selected (471 AS/AD cases in total).ResultsAll the included investigations were retrospective case series. AS/AD was often iatrogenic occurring at least in 0.01% of patients undergone endo-tracheal intubation. The most common symptom was persistent hoarseness. The diagnosis was made by video-laryngoscopy and neck computed tomography in most reports, while some used also laryngeal electromyography. Laryngeal electromyography was fundamental to rule out unilateral vocal fold paralysis, the main differential diagnosis. The surgical relocation of AS/AD under general or local anesthesia was achieved in about 80% of patients.ConclusionAS/AD is a mechanical disorder of the larynx that can be successfully treated if promptly diagnosed. Clinical trials and multi-centric studies are necessary to set management guidelines.
Background: Arytenoid cartilage dislocation is considered as a rare laryngeal injury and closed reduction is commonly used as the first choice for the arytenoid dislocation. However, the tools of closed reduction vary, and there is no dedicated tool for closed reduction, and the treatment outcome varies from person to person. This study compared the treatment outcome of the modified laryngeal forceps and traditional laryngeal forceps. Material and Methods: This study conformed to the strengthening the reporting of observational studies in epidemiology guidelines regarding retrospective studies. From May 2021 to February 2023, the records of 28 patients with arytenoid cartilage dislocation caused by endotracheal intubation were reviewed. They were divided into the traditional group ( n = 14) and the modified group ( n = 14) by gender. Indirect or direct laryngoscopy, video stroboscopy, high-resolution computed tomography, and cricoarytenoid joint 3-dimensional reconstruction were used to evaluate arytenoid position and motion. Clinical characteristics, voice function, procedural skill, and treatment outcome for each case were recorded. Results: Each patient was diagnosed with arytenoid dislocation caused by endotracheal intubation. There was no significant difference in the treatment outcome between the traditional group and the modified group ( P > .05). However, the median time interval between closed reduction and the return of normal voice in the traditional group was 31.08 ± 10.56 days, which was significantly longer than the median time of 17.92 ± 3.83 days in the modified group ( P < .05). Conclusion: Closed reduction with the modified laryngeal forceps under local anesthesia is an effective and safe procedure. Compared with traditional laryngeal forceps, the modified laryngeal forceps can shorten the treatment duration.
The article reported a novel reduction device and standardized reduction technique for patients with arytenoid dislocation. The results showed that this reduction technique has been excellent in helping patients with arytenoid dislocation. Laryngoscope, 2023.
Background:
Arytenoid dislocation is a rare complication after endotracheal intubation and may result in permanent hoarseness, which cannot be tolerated during cosmetic surgeries, such as facial bony contouring surgery. This study aimed to identify the clinical characteristics of this patient subgroup and share the process of diagnosis and treatment.
Methods:
We retrospectively collected the medical records of patients who underwent facial bony contouring surgery under general anesthesia with endotracheal intubation from September 2017 to July 2022. We divided the patients into a nondislocation group and a dislocation group. Demographic, anesthetic, and surgical characteristics were collected and compared.
Results:
441 patients were enrolled, and 5 (1.1%) were diagnosed with arytenoid dislocation. The patients in the dislocation group were more likely to be intubated with the video laryngoscope (P = 0.049), and head-neck movement during surgery may predispose patients to arytenoid dislocation (P = 0.019). The patients in the dislocation group were diagnosed around 5-37 days after surgery. Three of them regained their normal voice after close reduction, and two recovered with speech therapy.
Conclusion:
Arytenoid dislocation may result from multiple factors instead of one high-risk factor. Head-neck movement, the skills and experience of anesthetists, the time of intubation, and the use of intubation tools may all predispose patients to arytenoid dislocation. To acquire timely diagnosis and treatment, patients should be fully informed of this complication before surgery and observed closely afterward. Any postoperative voice or laryngeal symptoms lasting more than 7 days need a specialist evaluation.
Objective:
To assess the incidence of postoperative vocal cord immobility in patients following endotracheal intubation underwent general anesthesia.
Methods:
We retrospectively enrolled patients who underwent surgical procedures with endotracheal intubation under general anesthesia from January 2014 to December 2018 in Peking University First Hospital. Demographic and treatment data were obtained for patients with hoarseness and vocal cord fixation. The incidence of postoperative hoarseness and vocal cord fixation were presented and clinical outcomes were further analyzed.
Results:
A total of 85 998 patients following tracheal intubation and general anesthesia were enrolled in this study. Hoarseness was observed in 222 (0.26%) patients postoperatively. Sixteen patients (73%) were accomplished with symptoms of choking on water, dysphonia and sore throat. Twenty-nine patients with persistent hoarseness on the third postoperative day needed further treatment by otolaryngologists. Among them, seven patients had pharyngolaryngitis and twenty-two patients (0.026%) were demonstrated postoperative vocal cord immobility. There were seventeen patients (77%) with left-side vocal cord fixation and five patients (23%) with right-side vocal cord fixation. Nine patients were identified with arytenoid dislocation. Seven patients had left vocal cord fixation and two patients had right-side vocal cord fixation. Seven patients were intubated under the guidance of visual laryngoscope. One patient was confirmed difficult airway and intubated with light wand. One patient was inserted with laryngeal mask airway. One patient was suspected to have hoarseness caused by gastric tube before anesthesia. One patient showed simultaneously left recurrent laryngeal nerve abnormality on laryngeal electromyography result. The symptom of hoarseness ranged between 6 and 31 days. Three patients underwent closed reduction under local anesthesia and one patient demonstrated spontaneous recovery. Among the remaining thirteen patients with vocal cord immobility, two patients were demonstrated vocal cord paralysis. Eleven patients underwent neck surgery, thyroid surgery and cardiothoracic surgery and further examinations including laryn-geal electromyography and computed tomography help to determine the diagnosis were not performed. All patients were treated with inhaled corticosteroid conservatively. Five patients had significant improvement of symptom and almost regained normal voice. One patient had slight improvement and sixteen patients were not relieved before discharge.
Conclusion:
Patients with hoarseness and vocal fold immobility after endotracheal intubation should be treated properly and immediately.
Background: Closed reduction is an effective treatment for arytenoid dislocation. The treatment is usually given more than once to obtain normal voice. However, when to perform the next closed reduction remains controversial.
Objective: This study aimed to observe the regularity of the voice recovery and the arytenoid motion in patients with arytenoid dislocation after closed reduction.
Material and methods: Thirty-one patients were recruited from September 2017 to April 2019. Results of their clinical data were reviewed retrospectively.
Results: Among the thirty-one patients, their VHI scores, F0, jitter%, shimmer%, glottal-to-noise excitation %(GNE), maximum phonation time (MPT) and GRBAS Scale (G, R, B, A) improved significantly (p < .05), but there was no statistically significant difference for GRBAS Scale (S) (p>.05). The duration between last closed reduction and the restoring normal voice ranged from 1–8 days, with a mean of 4.65 ± 0.57 days, at the same time the glottis was completely closed.
Conclusions and significance: Closed reduction for patients with arytenoid dislocation is an effective procedure. A time window between 4.08th and 5.22th day (at a confidence level of 95%) after the last closed reduction was identified to be critical for voice recovery.
Purpose:
Arytenoid dislocation is a rare complication after tracheal intubation, and there are no published studies reporting on arytenoid dislocation during orthognathic surgery. The frequency of this phenomenon and the results of therapy were evaluated in this study.
Materials and methods:
Three of 5,032 patients who underwent orthognathic surgery during an 11-year period had a postoperative arytenoid dislocation. Closed reduction was used in these 3 patients. To check the therapeutic effect, arytenoid dislocation symptoms were recorded and acoustic analysis was performed before reduction, immediately after reduction, and 1, 2, and 4 weeks after reduction.
Results:
The incidence of arytenoid dislocation in orthognathic surgery was 0.0596%. The symptoms of 2 patients showed marked improvement 2 weeks after reduction with voice recovery and resolution of odynophagia. The symptoms of the other patient showed marked improvement 4 weeks after reduction. The treatment effects for all 3 patients were satisfactory.
Conclusion:
Arytenoid dislocation must be considered in cases of prolonged hoarseness after orthognathic surgery. Examination should be carried out as soon as possible, which can hasten the treatment of arytenoid dislocation and achieve a good outcome.
