Arytenoid dislocation: Diagnosis and treatment

Abstract

Disruption of the cricoarytenoid joint is a relatively uncommon event, according to the world literature. Only 31 reported cases of arytenoid dislocation or subluxation exist other than the 26 cases described in this paper. Often cases are misdiagnosed as vocal fold paralysis. Knowledge of the signs and symptoms of arytenoid dislocation aids in correct diagnosis and early treatment. Even when diagnosis has been delayed, surgery may be highly effective. Familiarity with state-of-the-art diagnostic techniques and new concepts in management helps optimize the chances for good voice quality.

Clinical Features and Surgical Outcomes Following Closed Reduction of Arytenoid Dislocation

“…1B, C), and laryngeal EMG (bilateral thyroarytenoid and cricothyroid muscles). The following clinical features were considered supportive of a positive arytenoid dislocation diagnosis: (1) history of a traumatic laryngeal event associated with sudden-onset dysphonia/dysphagia; (2) arytenoid positional displacement, arytenoid immobility with residual cuneiform motion, 12 and an absent jostle sign 10 on laryngeal endoscopy; (3) arytenoid positional displacement or frank cricoarytenoid joint obliteration on laryngeal CT; and (4) normal motor unit recruitment on laryngeal EMG. Patients with EMG-confirmed RLN paralysis, other neurolaryngological disorders, or vocal fold mucosal disease were excluded from the study.…”

“…Following a positive diagnosis, patients underwent direct laryngoscopy followed by CR, as described by Sataloff et al 10 Induction anesthesia was achieved using intravenous sedation and muscle relaxants. Arytenoid manipulation procedures were then performed during apneic anesthesia with intermittent ventilation.…”

“…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. 10,11 Existing evidence suggests that early identification and treatment is associated with a higher likelihood of arytenoid motion restoration and voice improvement.…”

“…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. 10,11 Existing evidence suggests that early identification and treatment is associated with a higher likelihood of arytenoid motion restoration and voice improvement. 2,3,8 Consequently, improved awareness and diagnostic algorithms among primary otolaryngologists and laryngologists are important to optimizing outcomes in this patient population.…”

“…1 These previous reports have variably relied on clinical history features, laryngeal endoscopy, computed tomography (CT) and electromyography (EMG); however, there remains no consensus on the most helpful diagnostic tools among these modalities. 1,2,6,10-12 Furthermore, no treatment studies have documented long-term stability of the repositioned arytenoid or quantitative vocal function change. Herein, in a 7-year prospective study at a single institution, we recruited 22 consecutive patients with arytenoid dislocation, collected comprehensive multimodal diagnostic data, performed direct laryngoscopy with closed reduction (CR), and evaluated arytenoid motion and vocal function outcomes up to 6 months after treatment.…”