Clinical characteristics of arytenoid dislocation in patients undergoing bariatric/metabolic surgery

Abstract

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.

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

“…Although difficult intubation is considered a risk factor for arytenoid dislocation [ 2 , 9 , 12 , 13 ], we found that Cormack grade, number of intubation attempts, or the use of an intubation stylet or BURP maneuver was not related to the occurrence of arytenoid dislocation. In addition, although a few studies have reported that body mass index [ 11 , 13 ], use of a orogastric tube [ 14 ] or esophageal stethoscope, and a longer duration of surgery [ 10 , 14 ] were risk factors for arytenoid dislocation, this was not the case in the current study. The discrepancies among studies are not readily explained.…”

“…In addition, arytenoid dislocation is frequently misdiagnosed as recurrent laryngeal nerve paralysis [ 3 , 4 ]. Moreover, the incidence of arytenoid dislocation may differ greatly among the type of surgery; it may be higher after bariatric/metabolic surgery with orogastric tube insertion (0.8%) [ 13 ], or in patients undergoing thyroid surgery (0.29%) as observed in the current study. These factors may explain why the incidence of arytenoid dislocation differs greatly among studies.…”

“…The finding that female patients ( vs male patients) were almost three times as likely to develop arytenoid dislocation (IRR = 3.05, P = 0.010) is puzzling, because in a few previous studies gender was not associated with arytenoid dislocation [ 9 , 11 , 13 ] Postoperative sore throat and hoarseness have been reported to be more common in women, probably due to the smaller larynx and tighter endotracheal tube fitting compared to men [ 22 , 30 , 31 ]. In addition, female gender has been associated with a higher incidence of postoperative complications, such as sore throat, hoarseness, nausea, and vomiting, probably due to differences in anatomical structure, hormonal effects, or emotional expression [ 32 ].…”

“…Several risk factors for this complication have been reported, including the use of a lighted stylet [ 2 ], laryngeal mask airway, or double-lumen tube [ 7 ]. Other factors include difficult intubation [ 2 , 9 , 12 , 13 ], a cardiovascular operation [ 9 ], high body mass index [ 11 , 13 ] and prolonged duration of operation [ 10 , 14 ]. However, there has been few systemic study regarding clinical risk factors that can predict the occurrence of arytenoid dislocation.…”

Delayed diagnosis of arytenoid cartilage dislocation after tracheal intubation in the intensive care unit: A case report

“…A review[ 1 ] reported that risk factors that weaken the CAJ include anemia, laryngomalacia, acromegaly, chronic steroid use, low body mass index (BMI)[ 11 ], Marfan syndrome, renal failure, gastroesophageal reflux disease (GERD), CHARGE (coloboma of the eye, heart defects, atresia of the choanae, retardation of growth, genital abnormalities, and ear abnormalities) syndrome[ 12 ]. The review also reported that the type and difficulty of intubation, operation time, type of intervention, use of transesophageal echocardiography during surgery[ 13 ], and insertion of a calibrating orogastric tube in bariatric surgery[ 14 ] were associated with a significant incidence of arytenoid cartilage dislocation.…”