Postintubation Arytenoid Subluxation

Talmi, Yoav P.; Wolf, Michiel W. P. de; Bar-Ziv, J; Nusem-Horowitz, Sima; Kronenberg, Jona

doi:10.1177/000348949610500511

Cited by 35 publications

(13 citation statements)

References 23 publications

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“…1-9 Although the overall incidence of arytenoid dislocation is unknown, it may be underdiagnosed and misidentified as recurrent laryngeal nerve (RLN) paralysis in certain patients. 2,6,10 Both arytenoid dislocation and RLN paralysis are characterized by arytenoid immobility resulting in dysphonia and potential dysphagia; however, accurate differential diagnosis is critical, as surgical management is disorder-specific.…”

Section: Introductionmentioning

confidence: 99%

Clinical Features and Surgical Outcomes Following Closed Reduction of Arytenoid Dislocation

Lee

Park

Welham

2014

JAMA Otolaryngol Head Neck Surg

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Importance Arytenoid dislocation is a rare condition characterized by vocal fold immobility and is easily mistaken as recurrent laryngeal nerve paralysis. Objective To describe presenting features, multimodal diagnostic evaluation, and surgical outcomes following closed reduction (CR) of arytenoid dislocation. Design, Setting and Participants Prospective case series at a single academic medical center. Evaluation and treatment data were obtained from 22 consecutive patients with arytenoid dislocation over a 7-year period. Interventions Patients underwent direct laryngoscopy and CR of the dislocated arytenoid, with adjunct injection laryngoplasty or botulinum toxin administration in select cases. Main outcomes and measures Initial diagnosis was confirmed using flexible laryngeal endoscopy with stroboscopy, computed tomography, electromyography, and interoperative palpation. Arytenoid motion (primary outcome measure) and vocal function data (secondary outcome measures) were collected before treatment and up to 6 months after treatment. Results Key history features included emergent intubation, elective intubation and external laryngeal trauma. Sixteen patients (73%) had anterior and 6 patients (27%) had posterior dislocation. One patient experienced spontaneous recovery. Following CR, with or without adjunct therapy, 18 of the remaining patients (86%) exhibited arytenoid motion recovery with concomitant voice improvement. Recovery was sustained at 6 months after CR. Closed Reduction performed within 21 days of the presumed dislocation event was associated with a superior arytenoid motion recovery rate. Conclusions and Relevance These data represent the largest clinical series on arytenoid dislocation with complete vocal function data and follow-up at 6 months after CR. These findings also corroborate existing evidence for early surgical intervention.

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Section: Introductionmentioning

confidence: 99%

Clinical Features and Surgical Outcomes Following Closed Reduction of Arytenoid Dislocation

Lee

Park

Welham

2014

JAMA Otolaryngol Head Neck Surg

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“…Schö n Ybarra, Department of Art as Applied to Medicine, The Johns Hopkins University School of Medicine, 1830 E. Monument Street, Suite 7000, Baltimore, MD 21205-2100. E-mail: M-Schoen@Worldnet.att.net been addressed in other terms, from different perspectives, and investigated with different methods (Sonesson, 1959;Frable, 1961;von Leden and Moore, 1961;Ardran and Kemp, 1966;Maue, 1970;Fink and Demarest, 1978;Sellars and Keen, 1978;Dickson and Maue-Dickson, 1982;Sellars and Sellars, 1983;Cé rat et al, 1988;Hirano et al, 1991;Hoffman et al, 1991;Neuman et al, 1993;Hengesteg et al, 1994;Sataloff et al, 1994;Faries and Martella, 1996;Talmi et al, 1996;Alexander et al, 1997;Cooke et al, 1997;Kasperbauer, 1998;Selbie et al, 1998;Wang, 1998), but its unequivocal elucidation and comprehension have been compromised by the use of methods that do not offer practical 3D sighting of CA joint facet movements and interactions, and very often by the use of inconsistent/inadequate nomenclature when referring to the movements of the arytenoids on the cricoid, to the interactions between the arytenoid and cricoid articular facets, and to the directions of the vocal process positional shifts. Moreover, realistic, truly informative illustrations that will support such elucidation and comprehension are not abundant in the cited references.…”

Section: Introductionmentioning

confidence: 99%

Topography and interactions of the arytenoid and cricoid articular facets: Implications for vocal process positional shifts

et al. 2004

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Using new computer applications and digital technologies, we provide a rigorous description and realistic illustrations of the arytenoid-on-the cricoid rotations. We also provide the articular facet topography and interactions that underlay those rotations and the concomitant vocal process positional shifts. The thyroid cartilage and all soft tissues were removed from three excised, preserved, normal, adult human larynges without disturbing the crico-arytenoid (CA) articular capsule. Three CA assemblies were thus prepared and used to digitize arytenoid rotations and vocal process positional shifts, and, after disarticulation, also the surface contour of the arytenoid and cricoid facets, and the cricoid lumen margin. The digitized data served to computer generate 2D and 3D graphic visualizations of the vocal process positional shifts, of the topography of the facets, and of the facet motion sequences that show that the anteroposteriorly concave arytenoid facet slides and conjunctly rotates on the anteroposteriorly convex cricoid facet. Visual details of all graphic representations and facet motion sequences were essentially identical across the three assemblies. Then, based on the computer generated data obtained from the largest of the CA assemblies, 3D, realistic, and hand-drawn images were made that illustrate the directions in which the arytenoids can rotate and the vocal processes concomitantly shift positions. Results indicate that when the arytenoids rotate by sliding from anterior to posterior on the cricoid facets about a primary axis of motion aligned from medial, posterior, and superior, to lateral, anterior, and inferior, their vocal processes shift positions along a plane obliquely oriented from anterior and medial, to posterior and lateral, and from inferior and medial, to superior and lateral.

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“…Acute injuries to the larynx following tracheal intubation are less common. Dislocation of the cricoarytenoid joint is a rare but serious complication ( 7, 8). This is believed to be a result of direct trauma from the blade of the laryngoscope, where the left arytenoid cartilage is dislocated more frequently than the right, owing to the nature of the instrument and the technique ( 8).…”

Section: Discussionmentioning

confidence: 99%

Pseudopolyp of the right laryngeal ventricle following atraumatic intubation: a diagnostic dilemma

Smith

Callanan

Lloyd-Thomas

et al. 2000

Pediatric Anesthesia

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The traumatic effects of tracheal intubation are well recognized. Whilst these usually follow prolonged intubation, acute lesions have been described, usually following a traumatic intubation technique. We present a case of acute, localized swelling of the right laryngeal ventricle which followed an entirely atraumatic intubation by an experienced paediatric anaesthetist. The lesion was not present at the time of intubation, but developed subsequently during the surgical procedure. Although previously observed at our institution, such lesions have not been described in the literature. The potential for a diagnostic pitfall, by mistaking the lesion for a laryngeal cyst or nodule, is discussed.

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Postintubation Arytenoid Subluxation

Cited by 35 publications

References 23 publications

Clinical Features and Surgical Outcomes Following Closed Reduction of Arytenoid Dislocation

Clinical Features and Surgical Outcomes Following Closed Reduction of Arytenoid Dislocation

Topography and interactions of the arytenoid and cricoid articular facets: Implications for vocal process positional shifts

Pseudopolyp of the right laryngeal ventricle following atraumatic intubation: a diagnostic dilemma

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