An unusual pattern of intubation injury?

Abstract

Post-intubation laryngeal dysfunction is well documented. Both common and rare patterns of injury have been described in the literature. An unusual pattern of intubation injury is described in this case report. The different patterns of post-intubation laryngeal injury are discussed as well as the possible aetiology in the case described.

Dysphonia secondary to traumatic avulsion of the vocal fold in infants

“…Cricoarytenoid dislocation, arytenoid subluxation, oesophageal perforation, tracheal rupture and retropharyngeal abscess formation have all been reported. Other than a previous report of case four from this current paper, 1 there have been no published descriptions of complete traumatic avulsion of the vocal fold secondary to intubation in the neonatal period. Traditionally, attention has been focused on the airway sequelae of paediatric intubation injuries; relatively little has been written on the detrimental effects to the voice.…”

Adverse Laryngeal Effects Following Short-term General Anesthesia<subtitle>A Systematic Review</subtitle>

“…6 These injuries may result in severe, prolonged laryngeal dysfunction. [7][8][9][10][11][12][13] Postoperative hoarseness, an important clinical sign of laryngeal injury or dysfunction, can be distressing to a patient. 4,8,12 It may have a negative effect on the patients' degree of satisfaction, as well as on their level of activity after hospital discharge.…”

“…These include ET size, cuff design, cuff pressure, type of tube, use of an introducer, use of a gastric tube, muscle relaxation, use of propofol, duration of the operation, intubation conditions, and movement of the tube, as well as demographic factors such as sex, weight, history of smoking and gastroesophageal reflux, or even the type of operation. 1,4,[7][8][9][10][11]18 Furthermore, removal of the LM with an inflated cuff, forced traction, or twisting of the LM may cause rotation of the larynx and possible dislocation of the arytenoids. 21 Severe cranial nerve injuries arising from pressure trauma have been associated with the LM.…”

Evaluation of the patient with hoarseness

“…Common causes are vocal cord granuloma, pressure paralysis of the recurrent laryngeal nerve and ulceration of the cricoarytenoid region. Less common are arytenoid subluxation, vocal cord tears and dislocation of the cricoarytenoid joint [32,33].…”