Arytenoid Dislocation Research Articles

Risk factors for and clinical progress in arytenoid dislocation after endotracheal intubation

Risk factors for and clinical progress in arytenoid dislocation after endotracheal intubation

Clinical characteristics of arytenoid dislocation in patients undergoing bariatric/metabolic surgery: A STROBE-complaint retrospective study.

Tracheal intubation and the use of a large-bore calibrating orogastric (OG) tube have been reported to increase the incidence of arytenoid dislocation (AD) in patients undergoing bariatric/metabolic surgery. This study aimed at identifying the clinical characteristics of this patient subgroup.We retrospectively examined the clinical characteristics of 14 patients with AD (study group) who received tracheal intubation and OG insertion for bariatric/metabolic surgery between 2011 and 2016. For comparison, another group of 19 patients with postoperative AD collected from published literature and 3 patients from the authors’ institute served as controls in whom only tracheal intubation was performed. Information on patient characteristics, anesthetic time, symptoms, time of symptom onset, intervention, and postinterventional impact on vocalization of the 2 groups were collected and compared.Patients in the study group were younger than those in the control group (38 [25–60] vs 54.5 [19–88] years, P = .03). Compared with the control group, anesthetic time (282.5 [155–360] vs 225 [25–480] minutes, P = .041) was longer and symptom onset (1.0 [0–6] vs 1.0 [0–6] days, P = .018) was more delayed in the study group. After closed reduction, the frequency of voice recovery was comparable in both groups in a time interval of 12 weeks (84.6% vs 92.9%, P = .59).Our report demonstrates that the clinical characteristics of patients with AD who received tracheal intubation and OG insertion for bariatric/metabolic surgery were different from those with postoperative AD receiving only tracheal intubation, highlighting the importance of implementing individualized strategies for AD prevention in this patient population.

Spontaneous arytenoid dislocation and crico-arytenoid instability

IntroductionArytenoid dislocation is a rare occurrence, for which the pathophysiology is still unclear. MethodsWe report here an unusual case of spontaneous arytenoid dislocation, which casts doubts on the prevailing classical theory of hemarthrosis. Results and conclusionsThis case and a review of the literature suggest that arytenoid dislocation could be linked to congenital or acquired arytenoid instability, thus facilitating arytenoid dislocation after even minor trauma. Once the diagnosis is established, we recommend to first attempt reduction, followed by speech therapy, though underlying diseases should be researched.

A Rare Complication Following Anesthesia: Arytenoid Dislocation During Orthognathic Surgery

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. 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 4weeks after reduction. The incidence of arytenoid dislocation in orthognathic surgery was 0.0596%. The symptoms of 2 patients showed marked improvement 2weeks after reduction with voice recovery and resolution of odynophagia. The symptoms of the other patient showed marked improvement 4weeks after reduction. The treatment effects for all 3 patients were satisfactory. 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.

Assessment of vocal cord movement by ultrasound in the ICU.

Ultrasound can be used to non-invasively and rapidly examine airway conditions, but vocal cord visualization with the traditional approaches is poor. Our aim was to compare the accuracies of front-side transverse-axis ultrasound (FTU), lateral-side longitudinal-axis ultrasound (LLU), and the combination of both approaches for vocal cord movement disorder diagnoses (e.g., vocal cord paralysis or arytenoid cartilage dislocation). We compared FTU, LLU, and the combination of both methods for patients in the intensive care unit (ICU). We used nasal fiber-optic endoscopy to confirm vocal cord injury. Among the 120 patients examined, 24 (20%) had vocal cord paralysis. The visualization rate of vocal cords for FTU was 71.7% (assessable, 86; non-assessable, 34), that for LLU was 88.3% (assessable, 106; non-assessable, 14), and that for the combined approach was 96.7% (assessable, 116; non-assessable, 4). The sensitivities and specificities were 58.3% (14/24) and 75% (72/96) for FTU, 91.7% (22/24) and 87.5% (84/96) for LLU, and 100% (24/24) and 95.8% (92/96) for the combined approach. Visualization rates for LLU were significantly higher than for FTU (P = 0.002); FTU + LLU rates were higher than those for FTU (P = 0.001). The difference between LLU and FTU + LLU was not statistically significant (P = 0.025). LLU can be used to evaluate arytenoid cartilage activity inICUs, and the results are highly correlated with the diagnosis of nasal fiber-optic endoscopy. The combination of FTU and LLU shows promise as a rapid primary screening method for vocal cord injury.

Bilateral Cricoarytenoid Joint Ankylosis with a Perplexing Etiology

Bilateral Cricoarytenoid Joint Ankylosis with a Perplexing Etiology

Association between the use of a stylet in endotracheal intubation and postoperative arytenoid dislocation: a case-control study

BackgroundsArytenoid dislocation (AD) is a rare but severe complication after general anesthesia with endotracheal intubation. We conducted a case-control study at Peking Union Medical College Hospital to identify risk factors associated with AD, including the use of an intubation stylet.MethodsPatients who experienced AD were matched 1:3 with controls based on gender, age and type of surgery. Multiple conditional logistic regression was performed to determine associations between potential risk factors and AD.ResultsTwenty-six AD cases were retrospectively identified from 2004 through 2016. On average, arytenoid dislocation occurred in 2 cases per year, with an incidence of 0.904/100,000 (approximately 0.01%). The 26 patients who experienced AD and 78 matched control patients were enrolled in this study. All enrolled patients underwent endotracheal intubation, and a stylet was used for intubation for 38.5% (10/26) of the AD patients and 64.1% (50/78) of the controls (OR = 0.23, 0.07–0.74). A higher incidence of AD was significantly associated with longer duration of operation (OR = 1.74, 1.23–2.47).ConclusionsThe use of an intubation stylet for endotracheal intubation appears to protect against AD. Prolonged operation time increases the risk of AD. These factors should be considered when assessing the risks of AD associated with endotracheal intubation and in efforts to avoid this complication.

The diagnostic value of laryngeal electromyography in vocal fold paralysis and arytenoid dislocation

To identify diagnostic value of laryngeal electromyography (LEMG) in differentiating vocal fold paralysis (VFP) from arytenoid dislocation. The history, laryngeal morphologic characteristics and LEMG of 36 patients with VFP and 10 patients with arytenoid dislocation were compared and analyzed. The most common cause of 36 VFP patients was surgical damage (24 cases), and the most common cause of 10 arytenoid dislocation patients was history of endotracheal intubation (9 cases). There was no statistical difference between the vocal fold and the fixed position of the vocal fold between the group of VFP patients and arytenoid dislocation patients. In the patients with VFP, 33 VFP patients (91.67%) had decreased recruitment; 9 cases (9/13) of denervation potential and 8 cases (8/9) of regeneration potential occurred within 1-6 months of the course of disease; 3 cases (3/4) of synkinesis occurred in the course of disease more than 6 months. In the patients with VFP, the amplitude (P<0.01) and turns (P<0.05) of thyroarytenoid muscles significantly decreased in the lesioned side comparing to the normal one, but the turns/amplitude ratio showed no statistical difference. In the patients with superior laryngeal nerve injury, the turns and amplitude analysis of cricothyroid muscles showed no statistical difference. All of 10 patients with arytenoid dislocation showed normal LEMG patterns. LEMG can be used to differentiate the patients with vocal cord paralysis from arthrodesis dislocation, and can also carry out quantitative analysis to provide valuable help for the diagnosis.

Clinical analysis of arytenoid cartilage reposition with snake mouth forceps for the arytenoid cartilage dislocation

To investigate the clinical effect of the arytenoid cartilage reposition using snake mouth reduction forceps under general anesthesia. Data of twenty-six cases accepted arytenoid cartilage reposition under intravenous general anesthesia were analyzed, nineteen cases accepted laryngeal CT scan and cricoarytenoid joint reconstruction, all patients underwent endolaryngeal muscle electromyography examination. According to the position of cartilage dislocation prompted by laryngoscope and CT, the arytenoid cartilage was repositoned under the visual laryngoscope using special snake mouth reduction forceps. If bilateral arytenoid cartilage were still asymmetrically at the end of the surgery, patients needed repeated reposition 1 to 2 times 1 week after operation. The efficacy was evaluated 4 weeks later. All patients had a hoarse and breathing voice preoperative. Under laryngoscope, there were different degrees of vocal cord movement disorders accompanied by incomplete glottis closure, 22 cases happened in left side and 4 in right side. The arytenoid cartilage was dislocated anteromedially in 25 cases and posterolaterally in 1 case. CT showed that 15 cases of arytenoid cartilage were tilted anteromedially; the interval of the cricoarytenoid joint was widened. In axial CT images, there were no direct signs of the arytenoid cartilage dislocation in the 4 cases, but the abnormal position was seen in the reconstruction images. The laryngeal electromyography indicated that 7 cases were abnormal, duration of motor unit potential were visible and the raising potential were mixed. There were 4 patients with normal voice in the first day after surgery, and 19 cases underwent twice and 3 cases underwent three times surgery. Vioce became normal in 4 weeks. Swallowing pain and bucking were all disappeared. Vocal cords movement were recovered to normal level in 25 cases. In 1 case with neck strangulation, the vocal cord movement was slightly worse than health side, but significantly better than that before operation. The arytenoid cartilage reposition using snake mouth reduction forceps under general anesthesia was an effective method for the treatment of the cricoary-tenoid joint dislocation.

Detection of Arytenoid Dislocation Using Pixel-valued Cuneiform Movement

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 etal 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 etal 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.

The clinical research of arytenoid dislocation

The clinical research of arytenoid dislocation

BMI May Be the Risk Factor for Arytenoid Dislocation Caused by Endotracheal Intubation: A Retrospective Case-Control Study

This study aimed to investigate the risk factors for postoperative arytenoid dislocation caused by endotracheal intubation. From September 2014 to September 2016, the records of 28 patients with a history of postoperative arytenoid dislocation were reviewed. Patients matched in type of anesthesia and surgery were chosen as the control (n = 56). Recorded data for all patients were demographics, smoking status, alcoholic status, operation time, and anesthesia procedures. For arytenoid dislocation cases, we further analyzed the incidences of the left and right arytenoid dislocations. Categorical variables were presented as frequencies and percentages, and were compared using the chi-square test. Continuous variables were expressed as means ± standard deviation and compared using the Student unpaired t test. To determine the predictors of arytenoid dislocation, a logistic regression model was used for multivariate analysis. Statistical significance was indicated by P < 0.05. Twenty-eight patients demonstrating postoperative arytenoid dislocation (10 women and 18 men) were included, with a mean age of 55 ± 12 years. Sixteen patients (57.14%) had left arytenoid dislocation and 12 (42.86%) had right arytenoid dislocation. Univariate analysis indicated that body mass index (BMI) was associated with arytenoid dislocation (P < 0.01), and logistic regression analysis showed that BMI (P = 0.025) was an independent risk factor for postoperative arytenoid dislocation. BMI might be the independent risk factor for postoperative arytenoid dislocation.

Arytenoid dislocation subsequent to difficult intubation

Dislocation of arytenoid cartilage from the crico-arytenoid joint is an uncommon complication due to intubation of larynx. In many cases, it is frequently mistaken as vocal cord paresis, laryngospasm, or laryngeal edema. Early diagnosis of the arytenoid dislocation and prompt treatment with reduction is crucial to avoid the need for more invasive methods and for a better prognosis of the condition. We report the case of a 50-year-old male with arytenoid dislocation following an uneventful coronary artery bypass graft surgery. He complained of persistent hoarseness following 15 days of the surgery. On fiber-optic laryngoscopic examination, the right vocal cord was immobile with minimal movement of arytenoid. A surgical reduction was performed by the otolaryngologist. The patient was relieved of the symptom postreduction.

Perioperative arytenoid cartilage dislocation: the causes, treatment and prognosis

Background Arytenoid cartilage dislocation is a rare complication in perioperative period, which is characterized with vocal cords immobility. The common symptoms are hoarseness and dysphagia. It is easily misdiagnosed as vocal cord paralysis. Objective To help doctors who are engaged in the perioperative treatments get a good knowledge of this complication--arytenoid cartilage dislocation. Content This paper briefly describes the anatomical structure of arytenoid cartilage, the causes of arytenoid dislocation, and its mechanism, clinical manifestations, diagnosis, treatment and prognosis. Trend It is of great clinical importance to get a good knowledge of perioperative arytenoid cartilage dislocation as well as early detection, early diagnosis and early treatment of it. Key words: Arytenoid cartilage; Dislocation; Perioperative

Pediatric Voice and Swallowing Disorders Related to Vocal Fold Immobility: the Use of Laryngeal EMG

Vocal fold immobility is a common cause of voice and swallowing disorders in children. The etiology of vocal fold immobility can be iatrogenic, idiopathic, neurological, or traumatic. Unilateral vocal fold immobility manifests as a weak or breathy voice and swallowing disorders such as aspiration. In contrast, bilateral vocal fold immobility typically presents with stridor or respiratory distress. Treatment for vocal fold immobility is based on symptoms. Patients with respiratory distress due to bilateral vocal fold immobility often require a tracheotomy, vocal cordotomy, arytenoidectomy, arytenoid abduction, or procedures to open the glottic airway. Surgical intervention for unilateral vocal fold immobility can include injection laryngoplasty, type 1 thyroplasty, or laryngeal reinnervation procedures. Timing for intervention with unilateral vocal fold immobility is difficult to determine for iatrogenic, traumatic, or neurologic injuries. Laryngeal electromyography (EMG) can help differentiate a neurologic etiology from vocal fold immobility from arytenoid dislocation. This diagnostic and prognostic information can help determine timing for definitive procedures such as laryngeal reinnervation.

The appropriate time for closed reduction using local anesthesia in arytenoid dislocation caused by intubation: a clinical research

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 window to perform closed reduction for unilateral arytenoid dislocation caused by intubation.Methods: A retrospective chart review was carried out for the cases collected from September 2014 to May 2016 at Second Affiliated Hospital of Zhejiang University, China.Results: Thirty-five patients with arytenoid dislocation were identified. Endotracheal intubation was the cause for 33 of the patients and gastric tube caused arytenoid dislocation in two patients. The patients were treated by closed reduction, and no major complications resulting from surgical intervention were observed. All patients regained normal voice and vocal fold movement after the surgery, except one patient who recovered spontaneously. As one of the most significant findings in the current study, we observed the relatively stable treatment outcomes and shortened recovery duration were obtained in the patients treated during a period between the 13th day and 26th day after arytenoid dislocation.

Extended cricotracheal resection with posterior costochondral grafting for complex pediatric subglottic stenosis

Background and objectiveSevere laryngotracheal stenosis in childhood poses a complex surgical challenge for specialists in airway surgery. Patients with severe subglottic stenosis with vocal cord involvement are particularly difficult to manage successfully. The goal of this work was to review our experience with extended CTR in a cohort of young children with severe SGS and determine which clinical parameters would be associated with surgical success. MethodsRetrospective analysis of the outcome of consecutive patients with severe glottic-subglottic stenosis submitted to an extended double-stage CTR between 2004 and 2014 at a large tertiary referral center. ResultsTwenty-five patients met inclusion criteria, with a mean age of 58.7 months at the time of repair. Overall decannulation rate was 80% (20/25), with a median time to deannulation of 120 days. Seven patients developed post-operative sequelae (4 arytenoid dislocations, 2 re-stenosis, and 1 anterior commissure adhesion). Patients with these sequelae had lower overall specific decannulation (42.8%) compared to those without any sequelae (94.4%) (Chi-square, p = 0.0123) with a longer time to decannulate (logrank, p = 0.0004). Notably, patients presenting with these sequelae on average had undergone a longer duration of post-operative stenting (27.14 days) compared to those presenting without any sequelae (14.8 days) (p = 0.0282). ConclusionsExtended CTR is an effective method for resolving a majority of severe glottic-subglottic stenosis cases in children. Duration of post-operative stenting may adversely impact overall outcome in these patients.

The role of acoustic analysis of fundamental frequency in differentiating arytenoid dislocation from vocal fold paralysis

Objective:Analysis of the sustained vowels of acoustic parameters in arytenoid dislocation and vocal fold paralysis. To investigate their acoustic characteristics and evaluate the role of this acoustic analysis method in differentiating arytenoid dislocation from vocal fold paralysis. Method:Thirty-three cases with unilateral vocal cord movement disorders were collected.All cases were divided into arytenoid dislocation group and vocal fold paralysis group through the laryngeal electromyography. Each group was further devided into male group and female group. The voice signals of sustained vowel of /a/ were measured using the software MDVP and obtain the acoustic parameters(Jitter, Shimmer, SPI and Fo). The acoustic characteristics between the two groups were observed and compared. Results were analyzed using Rank sum test for group design.Result:There were significant differences in Fo between arytenoid dislocation group and vocal fold paralysis group in both male and female group（P <0.05）. And mean rank order of Fo in arytenoid dislocation group was greater than vocal fold paralysis group. There were no significant differences in jitter,shimmer and SPI between arytenoid dislocation group and vocal fold paralysis group（P >0.05）.Conclusion:Mean rank order of Fo in arytenoid dislocation group is greater than vocal fold paralysis group in both the male and the female group. Fo is of value in differentiating arytenoid dislocation from vocal fold paralysis. This provides a theoretical basis for the acoustic analysis method to identify these two diseases.

Iatrogenic vocal process fracture and arytenoid dislocation caused by transesophageal echocardiography

Iatrogenic vocal process fracture and arytenoid dislocation caused by transesophageal echocardiography

Closed reduction for arytenoid dislocation under local anesthesia

Conclusion: Closed reduction under local anesthesia continues to be an effective and well-tolerated method for treating arytenoid dislocation. Bilateral arytenoid dislocation is an uncommon occurrence, and the principles of management are the same as for unilateral dislocation. Objectives: To evaluate the treatment outcomes of closed reduction for arytenoid dislocation under local anesthesia and to conduct an exhaustive review of the literature on bilateral arytenoid dislocation. Methods: Thirty-three patients with arytenoid dislocation were treated with closed reduction under local anesthesia. Arytenoid motion, GRBAS (grade, roughness, breathiness, asthenia, strain), maximum phonation time (MPT), self-assessed Voice Handicap Index (VHI), and acoustic voice analysis were used to evaluate the clinical outcomes. Results: Following closed reduction, 33 patients were divided into a ‘satisfied’ group (n = 26) and a ‘dissatisfied’ group (n = 7). In the ‘satisfied’ group, G, R, B, A, MPT, VHI, jitter%, shimmer%, normalized noise energy (NNE), and noise-to-harmonic ratio (NHR) were significantly improved compared with measurements taken before closed reduction (p < 0.05). The results for F0 and S score were not significantly different. In the ‘dissatisfied’ group, VHI, MPT, F0, and shimmer% were not significantly different 1 month after reduction. However, statistically significant change was observed in jitter% and NHR.