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

Abstract

BACKGROUND Arytenoid cartilage dislocation is a rare and often overlooked complication of tracheal intubation or blunt laryngeal trauma. The most common symptom is persistent hoarseness. Although cases of arytenoid dislocation due to tracheal intubation are reported more frequently in otolaryngology, reports on its occurrence in the intensive care unit (ICU) are lacking. We report a case of delayed diagnosis of arytenoid cartilage dislocation after tracheal intubation in the ICU. CASE SUMMARY A 20-year-old woman was referred to the ICU following a fall from a height. Her voice was normal; laryngeal computed tomography showed unremarkable findings on admission. However, due to deterioration of the patient’s condition, tracheal intubation, and emergency exploratory laparotomy followed by laparoscopic surgery two d later under general anesthesia were performed. After extubation, the patient was sedated and could not communicate effectively. On the 10 th day after extubation, the patient complained of hoarseness and coughing with liquids, which was attributed to laryngeal edema and is common after tracheal intubation. Therefore, specific treatment was not administered. However, the patient’s symptoms did not improve. Five d later, an electronic laryngoscope examination revealed dislocation of the left arytenoid cartilage. The patient underwent arytenoid closed reduction under general anesthesia by an experienced otolaryngologist. Reported symptoms improved subsequently. The six-month follow up revealed that the hoarseness had resolved within four weeks of the reduction procedure. CONCLUSION Symptoms of arytenoid cartilage dislocation are difficult to identify in the ICU leading to missed or delayed diagnosis among patients.

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

“…Patients in the intensive care unit may be at a greater risk of AD due to prolonged tracheal intubation, difficult intubation, nasogastric tube insertion, anemia, chronic steroid use, and low BMI. [ 7 ] In our cohort, the patients who underwent liver transplantation had prolonged tracheal intubation and the presence of a nasogastric feeding tube, indicating that the persistent pressure exerted by tracheal tubes or nasogastric tubes is a possible cause of AD. An animal study indicated that the tracheal tube could exert pressure in the region of the arytenoid cartilage when the tracheal tube was left in situ.…”

“…[5,6] If left untreated, undiagnosed, or misdiagnosed, AD could lead to hypermobile joint or ankylosis of the affected cricoarytenoid joint (CAJ). [7] The underlying mechanisms of AD are still elusive. Previous studies suggested that direct trauma by a laryngoscope or intubation tube is responsible for dislocation of the CAJ.…”

“…[ 5 , 6 ] If left untreated, undiagnosed, or misdiagnosed, AD could lead to hypermobile joint or ankylosis of the affected cricoarytenoid joint (CAJ). [ 7 ]…”