Idiopathic Arythenoid Subluxation

Abstract

Arytenoid subluxation is a rare laryngeal injury that may follow instrumentation of the airway and refers to the partial displacement of the arytenoid within the cricoarytenoid joint. Knowledge of its clinical presentation helps in the correct diagnosis and early treatment. 80 year old male patient with no significant past history came complaining of dysphagia to solids for the last week. He reported only tolerating liquids and denied trauma, unintentional weight loss, hoarseness, odynophagia, fever, chills, night sweats, hematemesis, hemoptysis, cough, shortness of breath, or abdominal pain. He did report undergoing a Nissen fundoplication 20 years ago, no other events of airway manipulation. On examination, vital signs were within normal limits. No hoarseness or muffled voice was appreciated. No neck erythema, masses, thyromegaly, JVD, or lymphadenopathy were present and respiratory and abdominal exam were also overall unremarkable. Basic metabolic panel revealed blood glucose within normal limits, a hemoglobin a1c of 6.2. ANA and rheumatoid factor came back negative. Barium swallow evaluation did not reveal strictures or mucosal irregularities. CT of the neck did not show signs of infections or abscess and subsequent upper endoscopy revealed a subluxated left arythenoid. Patient underwent speech therapy evaluation, and was recommended to start a soft mechanical diet. He tolerated this well, and was discharged from the hospital with a follow up appointment with ENT and speech therapy. He was advised to keep the head of his bed elevated at bedtime, and to avoid large meals before bedtime. Outpatient laryngoscopic evaluation showed the subluxated left arythenoid. The patient declined corrective surgery. He has noticed minor improvement since he was discharged from hospital. Arythenoid subluxation is found in less than 1 of every 100 direct laryngoscopic intubations. It differs from arythenoid dislocation by the fact it is a partial displacement of the arthenoid while the latter describes a complete separation. Recent airway instrumentation is by far the most described cause. The classic presenting symptom, hoarseness, is acute, and tends to occur in the recovery room. Less common presenting symptoms include odynophagia, dysphagia, and cough. Airway compromise is very rare. Chronic arythenoid subluxation has not been described before. Diabetes mellitus and connective tissue diseases are risk factors, and should be considered if no other explanation is found.