Arytenoid Dislocation Research Articles

Incidence and Risk Factors of Arytenoid Dislocation Following Endotracheal Intubation: A Systematic Review and Meta-Analysis.

Endotracheal intubation carries risks, including arytenoid dislocation (AD), a rare but severe complication. Due to small sample sizes, the incidence of AD varies considerably among studies. Proposed risk factors for AD include difficult intubation, prolonged intubation, certain surgeries, patient positioning, female sex, and BMI. This review aims to investigate the incidence of AD and explore the various predisposing risk factors. We retrieved relevant studies up to April 2024 from PubMed, Scopus, Web of Science, and the Cochrane Library. Using OpenMeta v5.26.14 software (Institute for Clinical Research and Health Policy Studies at Tufts Medical Center, Boston, USA), we pooled AD incidence rates from individual studies. Other outcomes, reported in fewer studies and thus not suitable for meta-analysis, were synthesized manually. Study selection yielded 16 eligible articles. A random-effects model analysis of nine studies found a significant AD incidence rate of 0.093% (confidence interval (CI): 0.045% to 0.14%), but the results were highly heterogeneous (I2 = 91%). Older age was associated with prolonged hoarseness, while younger age and female sex increased the risk of AD. Additionally, AD risk factors included taller stature, higher BMI, specific surgeries, esophageal instrumentation, prolonged procedure durations, head-neck movement, and inexperienced intubators. However, intubation with a stylet reduced the AD risk. AD post-endotracheal intubation is rare (incidence: 0.09%), with potential underdiagnosis in larger datasets. Many risk factors may contribute to the condition, but the small number of studies per risk factor limits the ability to draw robust conclusions. Subjective diagnoses and retrospective studies further restrict comprehensive understanding. Further research is needed to explore AD risk factors effectively.

Modified Laryngeal Forceps for Arytenoid Cartilage Dislocation Caused by Endotracheal Intubation: A Retrospective Case-Control Pilot Study.

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.

Prolonged Tracheal Intubation in the ICU as a Possible Risk Factor for Arytenoid Dislocation After Liver Transplant Surgery: A Retrospective Case-Control Study.

BACKGROUND Arytenoid dislocation (AD) is a rare complication of general anesthesia with tracheal intubation, with a published incidence of 0.009-0.097%. This retrospective case-control study aimed to identify risk factors associated with AD in patients who underwent liver transplantation. MATERIAL AND METHODS This study included 476 patients who underwent liver transplantation between January 2013 and December 2022. Patients with AD who underwent surgery were included in the AD group. For each case of AD, 4 patients matched by anesthesia type and anesthetist were randomly selected as the non-AD group. Data on patient characteristics, anesthetic factors, and surgical factors were collected and compared between patients with and without AD. Logistic regression analysis was performed to determine the risk factors for AD after liver transplantation. RESULTS Of the 476 patients who underwent liver transplantation, 17 (3.57%) had AD. AD occurred on the left side in 13 patients and on the right side in 4 patients. The 17 patients who experienced AD and 68 matched non-AD patients were enrolled. Patients in the AD group had a greater intubation depth (24 [23-24] vs 24 [24-24], P=0.043), a higher level of hemoglobin (134.5 [118-147.5] vs 112 [96.25-125], P=0.014), and prolonged tracheal intubation in the ICU (19.75 [15.87-31.87] vs 13 [10.62-15], P<0.001) compared to those in the non-dislocation group. Multivariate logistic regression analysis showed that prolonged tracheal intubation in the ICU was independently associated with the occurrence of AD in patients who underwent liver transplantation (P=0.013). CONCLUSIONS This study showed that the incidence of AD was 3.57% in patients undergoing liver transplant surgery and that prolonged tracheal intubation in the ICU was a possible risk factor for AD.

High prevalence of postoperative arytenoid dislocation in patients undergoing liver transplantation: A case-control study.

Arytenoid dislocation (AD) is a rare complication of surgery under general anesthesia. The potential factors for AD remain poorly defined, and the identification of risk factors is beneficial for reducing its incidence. We found that patients undergoing liver transplantation appeared to be more susceptible to postoperative AD at our hospital. The present study was designed to clarify this issue. A retrospective hospital-based case-control study was conducted in patients undergoing surgery under general anesthesia between 2017 and 2021. Recorded data for all patients were age, sex, body weight, height, body mass index, position of patients during surgery, duration of surgery, emergency status of surgery, and liver transplantation. Logistic regression analysis was performed to determine risk factors for AD. Thirty thousand one hundred fifty-four patients who underwent general anesthesia between 2017 and 2021 were included. Sixteen (0.05%) patients were diagnosed with AD, including 10 (3.9%) patients among 259 patients who underwent liver transplantation and 6 patients had complications among the 29,895 patients who underwent other operations (P < .0001). Postoperative AD incidence was significantly elevated in patients undergoing liver transplantation. This finding should be clinically relevant and alarming for anesthesiologists and clinicians to help avoid arytenoid dislocation and improve patient outcomes. Further studies that incorporate detailed data are needed to determine risk factors for AD.

Hoarseness and arytenoid dislocation: A rare complication after facial bony contouring surgery

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. 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. 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. 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.

Incidence of Airway Complications in ICU.

To show the incidence of airway complications in ICU. Endotracheal intubation is an essential skill performed by multiple medical specialists to secure a patient's airway as well as provide oxygenation and ventilation through the oral route or nose. The goal of endotracheal intubation in the emergency setting is to secure the patient's airway and obtain first-pass success. There are many indications for endotracheal intubation, including poor respiratory drive, questionable airway patency, hypoxia, and Hypercapnia. These indications are assessed by evaluating the patient's mental status, conditions that may compromise the airway, level of consciousness, respiratory rate, respiratory acidosis, and level of oxygenation. In the setting of trauma, a Glasgow Coma Scale of 8 or less is generally an indication for intubation. There are many different complications of intubation as hoarseness of voice, dental injuries, arytenoid dislocation, laryngeal stenosis, tracheal stenosis and tracheomalacia. . 150 patients who were sat in the ICU that developed certain complications. 86 patients (57.3%) were sitting in the ICU develoed certain complications. Liver diseases were the main cause of ICU admission 34 (22.7%) patients then shock 32 (21.3%) patients. Blockage of endotracheal tube was the main ICU complications 18 (12%) patients then sinusitis 16 (10.7%) patients. Endotracheal intubation is a lifesaving procedure and its complications are significant problems in ICUs. A successful procedure of intubation avoids complications. Skilled endotracheal intubation in the ICU decreases the complications.

Closed External Trauma of the Larynx: About Four Cases Collected in Bamako

Objective: The purpose of our work was to review through four observations the mechanisms of injury, the main signs calling for classification in the management of blunt external trauma to the larynx in a hospital of last resort in Mali. Observations: We reported a series of four cases of blunt external trauma to the larynx, all of which occurred in the context of a public road accident (AVP) with reception of the shock at the level of the anterior part of the neck. Dysphonia was the most constant sign, it was associated with dyspnea. All our patients had benefited from a Nasofibroscopy or a direct laryngoscopy and a pharyngolaryngeal computed tomography allowing them to be classified according to the classification of Schaefer and Fuhmann. A patient with arytenoid dislocation underwent endoscopic reduction. Exploratory cervicotomy was performed in one patient. Conclusion: Adequate management of external trauma to the larynx requires a structured, rapid and precise diagnostic and therapeutic approach. This constitutes a challenge in our context where the mobilization of the patient and the diagnostic means (nasofibroscopy or a direct laryngoscopy, pharyngolaryngeal computed tomography) in the absence of third-party payment are part of a course of overcoming obstacles.

A Study on Laryngeal Trauma Caused by External Damage

Objectives: Laryngeal trauma caused by external factors is rare. The treatment strategies for laryngeal trauma, including the optimal surgical approaches, airway management methods, and fixation materials to be used still remain under debate.Methods: We retrospectively analyzed the details of the management and clinical course of 16 patients with fresh laryngeal trauma treated between April 2000 and March 2020 at the Hiroshima University Hospital.Results: The causes of the laryngeal trauma included sports accident (n = 6), fall (n = 3), suicidal behavior (n = 2), labor accident (n = 2), and other (n = 3). Categorization of the severity and the treatment policy, including the surgical indications, were in accordance with the classification proposed by Umeno et al. We performed surgical repositioning of the fractured thyroid cartilage in 7 cases and repositioning or correction of arytenoid cartilage dislocation in 2 cases under general anesthesia. The fixation materials used varied depending on the need.Conclusion: The clinical features of laryngeal trauma were examined. Further studies on fixation methods, methods to restore the phonation ability, and appropriate surgical timing are required.

The Diagnosis and Treatment of Arytenoid Dislocation

Vocal fold paralysis and arytenoid dislocation are the differential symptoms for unilateral vocal fold movement disorder. However, their diagnosis is difficult. To diagnose dislocation, it is necessary to understand the movements characteristic of unilateral fold paralysis. A particularly important finding of paralysis is the passive gliding movement that is displaced in the cranial direction during phonation. The presence of this movement is diagnostic of paralysis rather than dislocation. A number of previous reports on dislocation have diagnosed the presence of this passive movement as dislocation. In Japan, the term ‘fixation’ is often used to describe the position of the paralyzed vocal folds, as in ‘mid-position fixation’ or ‘sub-median fixation’. There seems to be a misconception that ‘paralyzed vocal cords are immobilized’. In the case of dislocation, by contrast, the muscular process is unable to move beyond the midline of the articular surface, and the movement of the arytenoid is severely restricted and immobile. It has been misunderstood that immobility is paralysis while wobbling is dislocation. However, paralysis is the presence of wobbling movement (passive gliding movement), and dislocation is immobilization and inability to move. Dislocations have previously been divided into two categories of anterior and posterior dislocations, but vertical dislocations have not been mentioned. In past reports, the terms ‘anterior’,‘posterior’,‘medial’, and ‘lateral’ have been used to refer to the position of dislocation. However, these terms do not indicate the position in the vertical direction. We divided the cricoid facet into four areas: mediocaudal, laterocaudal, mediocranial and laterocranial. We published on recurrent adductor branch paralysis in 2010. Gradually, the concept of partial laryngeal palsy has become more widespread. Looking at previous reports, adductor branch paralysis may have been included in many studies diagnosing posterior dislocation (mediocranial). Understanding the characteristics of adductor branch paralysis is crucial. It is important to understand the three-dimensional arrangement of the arytenoid cartilage for the diagnosis of unilateral vocal fold movement disorder and clarifying the characteristics of paralysis.

Risk factors of arytenoid dislocation after endotracheal intubation: A propensity-matched analysis.

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. 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. 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 3h (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. 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. III.

Clinical report of hoding cricoarytenoid joint reduction with visual laryngoscope under intravenous anesthesia

Objective: To investigate the reduction effect of hoding cricoarytenoid joint reduction with visual laryngoscope under intravenous anesthesia. Methods: The therapeutic effects of 40 patients with arytenoid dislocation(AD)treated by closed reduction in the single center from January 2020 to September 2021 were retrospectively analyzed, including 21 males and 19 females, median age 48 years. The etiology, symptoms, preoperative evaluation methods, reduction mode, reduction times, and the recovery of arytenoid cartilage movement and sound after reduction were evaluated and analyzed. Results: All patients had obvious hoarseness and breath sound before treatment. Under stroboscopic laryngoscope or electronic nasopharyngoscope, different degrees of vocal cord movement disorder and poor glottic closure can be seen. There were 28 cases of left dislocation, 9 cases of right dislocation and 3 cases of bilateral dislocation. The etiology of dislocation of cricoarytenoid joint: 25 cases (62.5%) of tracheal intubation under general anesthesia were the most common causes, was as follows by laryngeal trauma, gastroscopy, cough, vomiting and so on. Among them, 28 cases of reduction were initially diagnosed in our department, and 12 cases were diagnosed later after failure of reduction treatment. Of the 40 patients, 6 underwent reduction 24 hours after dislocation; 18 cases from 3 days to 1 month; 7 cases from 1 to 3 months; 6 cases were reset in 3~6 months; Over 6 months in 3 cases. After one reduction, 10 cases (10/40, 25%) recovered normal pronunciation, 14 cases (14/40, 35%) recovered normal pronunciation after two reduction, 10 cases (10/40, 25%) recovered normal pronunciation after three times, 2 cases (2/40, 5%) recovered normal pronunciation after four times, and 1 case (2.5%) recovered normal pronunciation after five times. Thin slice CT scan of larynx and cricoarytenoid joint reconstruction showed the types of AD: subluxation in 37 cases (92.5%) and total dislocation in 3 cases; 28 cases of left dislocation, 9 cases of right dislocation and 3 cases of bilateral dislocation; 29 cases (72.5%) had posterior dislocation and 11 cases (27.5%) had anterior dislocation. All patients were treated by intravenous anesthesia with arytenoid cartilage clamped by cricoarytenoid joint reduction forceps under visual laryngoscope. The curative effect was evaluated by stroboscopic laryngoscope and/or voice analysis at 1-2 weeks after operation. The vocal cord movement returned to normal and the pronunciation was good in 37 cases (92.5%). Conclusions: Hoding cricoarytenoid joint reduction with the vision laryngoscope under intravenous anesthesia is easy to operate and the reduction effect is more stable. It is a effective method for AD.

A Case of Anterior Arytenoid Cartilage Dislocation during Nasal Tracheal Intubation Using an Indirect Video Laryngoscope

A Case of Anterior Arytenoid Cartilage Dislocation during Nasal Tracheal Intubation Using an Indirect Video Laryngoscope

REVEALING THE GENETIC ARCHITECTURE OF BIPOLAR DISORDER AND SUBTYPES PROVIDES BIOLOGICAL INSIGHT

This study aims to assess utility of pixel-valued movement software in detecting arytenoid dislocation preoperatively.This is a retrospective analysis.Twenty-seven patients diagnosed with unilateral arytenoid dislocation were included. Diagnosis of arytenoid dislocation was confirmed by lack of vocal fold paralysis on preoperative laryngeal electromyography and by intraoperative findings of cricoarytenoid dislocation. A region-tracking software algorithm developed by Zhuang et al was used to analyze 27 preoperative endoscopic videos of patients diagnosed with arytenoid dislocation. Vector analysis measuring cuneiform movement during inspiration was used as an indirect measure of arytenoid movement. Values were normalized using vocal fold length. Two raters blinded to diagnosis of arytenoid dislocation measured vocal fold length and cuneiform movement on both the dislocated and the nondislocated sides.A Wilcoxon signed-rank test indicated that the mean pixel-valued cuneiform movement and standard deviation (SD) were greater for nondislocated (159.24, SD = 73.35) than for dislocated (92.49, SD = 72.11) arytenoids (Z = 3.29, P = 0.001). The interrater correlation coefficient was 0.87 for the dislocated side and 0.75 for the nondislocated side. The intrarater correlation coefficient was 0.87 for the dislocated side and 0.91 for the nondislocated side. The receiver operating characteristic curve revealed an area under the curve between 0.76 and 0.83 (95% confidence interval 0.63–0.90). Analysis by the first and second raters revealed misdiagnosis of laterality of arytenoid dislocation in four and six patients, respectively.The software program developed by Zhuang et al provides a high-degree of precision, with good interrater and intrarater correlation coefficients. However, high rates of misdiagnosis of arytenoid dislocation and the laborious analysis process using this software program make it of limited utility as a clinical diagnostic tool in its present state.

Head-neck movement may predispose to the development of arytenoid dislocation in the intubated patient: a 5-year retrospective single-center study

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.

A hybrid nasal intubation technique for the head and neck surgical patient: a case series and review of the literature

Purpose The inherent morbidity associated with intubation, especially nasal intubation, is well documented in the literature. Risks include vocal cord trauma, arytenoid dislocation, and trauma throughout the nasopharynx and the larynx. Furthermore, repeated intubation attempts are associated with increased patient morbidity and mortality. The head and neck surgical patient poses a unique challenge to the anesthesiologist, presenting with a difficult airway in addition to often requiring nasal intubation for surgical access. This case report series evaluates a hybrid technique that applies existing difficult airway strategies as a standard combined approach in the head and neck surgical patient without trismus. Nasal intubation is achieved with direct laryngoscopy, with or without the assistance of Magill forceps, fiberoptic scopes, and video laryngoscopes, to minimize nasopharyngeal trauma. Our method combines the standard armamentarium for rescue techniques into a hybrid approach. Methods Once anesthesia is induced and after topicalization with lidocaine and oxymetazoline, a nasal Ring-Adair-Elwyn (RAE) endotracheal tube is passed through the favorable nostril and into the nasopharynx. The video laryngoscope is next used to visualize the glottis. Once the tip of the nasal RAE is advanced and visualized near the glottic opening, a fiberoptic scope is passed through the nasal RAE. Two video screens are used simultaneously to guide the fiberoptic scope and subsequently the endotracheal tube through the glottis. Results The 3 patients described in this article were successfully intubated by using this approach, without the use of Magill forceps. This resulted in minimal trauma, fewer intubation attempts, and comparable intubation time. Conclusions Although neither the constituents nor the techniques are unique, they are usually reserved as mutually exclusive rescue measures for managing the difficult airway. We believe this hybrid technique may become the standard of care for the majority of head and neck surgical patients requiring nasal intubation. This decreases the risk of nasopharyngeal and laryngeal trauma and does not increase cost because the video laryngoscope and the fiberoptic scope are standard equipment available in most hospitals. This approach may decrease patient morbidity and reduce total intubation time.

Clinical outcomes of vocal fold immobility after tracheal intubation

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.

Current management of arytenoid sub-luxation and dislocation.

To review the current management of arytenoid subluxation/dislocation (AS/AD) focusing on diagnostic, therapeutic, and prognostic controversies. The international literature of the last 20years has been considered. After the application of inclusion criteria, 20 studies were selected (471 AS/AD cases in total). All 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. AS/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.

The Analysis of Immobile Vocal Folds Using Three-Dimensional Computed Tomography for the Correct Diagnosis and Determination of the Treatment Strategy

Understanding the three-dimensional (3D) movement of immobile vocal folds (VFs) is very important. Because endoscopic findings reflect only the two-dimensional movement of VFs, it is impossible to obtain a correct diagnosis. The cases presented in this article include not only those of unilateral vocal fold paralysis (UVFP) but also arytenoid dislocation, laryngeal scarring and other statuses. The main diseases are described below.

Regularity of voice recovery and arytenoid motion after closed reduction in patients with arytenoid dislocation: a self-controlled clinical study

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.

Treatment Outcomes of Arytenoid Dislocation by Closed Reduction: A Multidimensional Evaluation

This study aimed to investigate the treatment outcomes of arytenoid dislocation by a multidimensional evaluation. From April 2010 to May 2018, the records of 57 patients with a history of arytenoid dislocation were reviewed. All the patients were treated with closed reduction under local anesthesia. Arytenoid motion, grade, roughness, breathiness, asthenia, strain, maximum phonation time, self-assessed Voice Handicap Index, and acoustic voice analysis were used to evaluate the clinical outcomes. Following closed reduction, 57 patients were divided into "recovered" (n = 24), "improved" (n = 15), and "ineffective" (n = 18) groups. There were no major complications resulting from surgical intervention. Closed reduction under local anesthesia continues to be an effective and well-tolerated method for treating arytenoid dislocation. The trichotomy of the treatment results of arytenoid dislocation by a multidimensional evaluation may be more accurate to evaluate the results of arytenoid dislocation.