Abstract
BackgroundArytenoid dislocation is a rare laryngeal injury that may follow endotracheal intubation. We aimed to determine the incidence and risk factors for arytenoid dislocation after surgery under general anaesthesia.MethodsWe reviewed the medical records of patients who underwent operation under general anaesthesia with endotracheal intubation from January 2014 to December 2018. Patients were divided into the non-dislocation and dislocation groups depending on the presence or absence of arytenoid dislocation. Patient, anaesthetic, and surgical factors associated with arytenoid dislocation were determined using Poisson regression analysis.ResultsAmong the 25,538 patients enrolled, 33 (0.13%) had arytenoid dislocation, with higher incidence after anterior neck and brain surgery. Patients in the dislocation group were younger (52.6 ± 14.4 vs 58.2 ± 14.2 yrs, P = 0.025), more likely to be female (78.8 vs 56.5%, P = 0.014), and more likely to be intubated by a first-year anaesthesia resident (33.3 vs 18.5%, P = 0.048) compared to those in the non-dislocation group. Patient positions during surgery were significantly different between the groups (P = 0.000). Multivariable Poisson regression identified head-neck positioning (incidence rate ratio [IRR], 3.10; 95% confidence interval [CI], 1.50–6.25, P = 0.002), endotracheal intubation by a first-year anaesthesia resident (IRR, 2.30; 95% CI, 1.07–4.64, P = 0.024), and female (IRR, 3.05; 95% CI, 1.38–7.73, P = 0.010) as risk factors for arytenoid dislocation.ConclusionThis study showed that the incidence of arytenoid dislocation was 0.13%, and that head-neck positioning during surgery, less anaesthetist experience, and female were significantly associated with arytenoid dislocation in patients who underwent surgeries under general anaesthesia with endotracheal intubation.
Highlights
Arytenoid dislocation is a rare laryngeal injury that may follow endotracheal intubation
Endotracheal intubation during general anaesthesia can lead to complications such as submucosal hemorrhage, subglottic edema or laryngitis, vocal cord immobility, arytenoid dislocation and tracheal stenosis
Our study demonstrated that intubation by a firstyear anaesthesia resident was an independent risk factor for arytenoid dislocation, suggesting that the technical skills of the operator performing endotracheal intubation are important
Summary
Arytenoid dislocation is a rare laryngeal injury that may follow endotracheal intubation. We aimed to determine the incidence and risk factors for arytenoid dislocation after surgery under general anaesthesia. Endotracheal intubation during general anaesthesia can lead to complications such as submucosal hemorrhage, subglottic edema or laryngitis, vocal cord immobility, arytenoid dislocation and tracheal stenosis. Arytenoid dislocation (presenting as hoarseness, breathy voice, vocal fatigue, swallowing difficulty, and sore throat) is a very rare laryngeal injury, occurring in less than 0.1% of patients after general anaesthesia [2, 3]. In patients with persistent hoarseness, arytenoid dislocation should be considered. When this complication is early diagnosed and promptly treated, the prognosis is generally favorable [5]. Identification of the risk factors for this complication may reduce its occurrence by enabling clinicians to avoid its triggers
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