Abstract
Incidence of arytenoid cartilage dislocation for patients treated or examined under general anesthesia with tracheal intubaion in one hospital had not been reported. And true incidence and mechanism of arytenoid cartilage dislocation after tracheal intubation are not investigated yet. Here, we examined retrospectively the incidence of arytenoid cartilage dislocation for patients after general anesthesia with tracheal intubaion in the Central Surgical Center of Nippon Medical School Main Hospital for two years from 2004 until 2005. The incidence of arytenoid cartilage dislocation for patients after general anesthesia with tracheal intubaion was 0.2%, and patients received cardiovasucular surgeries were the most common. The mean age of the patients with arytenoid cartilage dislocation was 70 years. It could be considered that additional medical instrumentation of the esophagus including transesophageal echocaridiography probe or upper gastrointestinal endoscopy, and prolonged tracheal intubation for more than two days should be the risk factors causing arytenoid cartilage dislocation. And calcification of the laryngeal cartilage and morphological changes of the cervical vertebrae along with aging might also contribute to dislocate the arytenoid cartilage.
Highlights
It had been recognized that the arytenoid cartilage dislocation may be caused by medical instrumentation used with the larynx and esophagus, and external neck trauma such as whiplash injury [1,2,3]
Medical instrumentation such as endotracheal intubation, laryngeal airway mask intubation [3], upper gastrointestinal endoscopy [4] and transesophageal echocardiography probe [5] may be responsible for complications
Over-zealous use of lighted stylet for the tracheal intubation, traumatic insertion of laryngoscope blade, prolonged endotracheal intubation, or extubation with a partially deflated cuff were reported as the causes of arytenoid cartilage dislocation [6,7]
Summary
It had been recognized that the arytenoid cartilage dislocation may be caused by medical instrumentation used with the larynx and esophagus, and external neck trauma such as whiplash injury [1,2,3]. The diagnosis of the arytenoid cartilage dislocation was made by the use of a video-laryngeal fiberscope, palpation of the cricoarytenoid joint, and fluorography of the larynx on repetitive phonation of the glottal fricative sound/he/ [10,11]. The video-fluorography of the larynx on repetitive phonation of the glottal fricative sound/he/ showed an abnormally high and diagonal displacement of the vocal fold on the dislocated side on the upper structure of the arytenoid cartilage. Any evidence of trauma, such as submucosal hemorrhage, edema, granulomatous tissue formation, ulceration, or scar tissue around the vocal process of the arytenoid cartilage was noted using a fiberscope
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