Pediatric Arytenoid Dislocation: Diagnosis and Treatment

Mallon, Andrew; Portnoy, Joel E.; Landrum, Tré; Sataloff, Robert T.

doi:10.1016/j.jvoice.2013.08.016

Cited by 13 publications

(11 citation statements)

References 32 publications

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“…[6] Other etiologic factors of AD are laryngeal mask use, upper gastrointestinal endoscopy, lighted stylet trauma, McCoy laryngoscope and double lumen tube injury, blind instrumentation of the esophagus with a rigid nasogastric tube and transesophageal echocardiogram probe as well as challenging intubation. [7] Although AD alone has been reported previously, we could find no data on VP fracture accompanying AD as found in our unique case. It has been speculated that there are some risk factors making the joint susceptible to traumatic dislocation including renal disease, inf lammatory bowel disease, rheumatoid arthritis, acromegaly and chronic steroid administration.…”

Section: Discussioncontrasting

confidence: 68%

Iatrogenic vocal process fracture and arytenoid dislocation caused by transesophageal echocardiography

Binnetoğlu¹

2016

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Aritenoid dislokasyonu (AD) larengeal travmaya sekonder gelişebilen nadir bir durumdur. Aritenoid dislokasyonu ile birlikte olan vokal proses kırığına tanı koymak için fiberoptik larengoskopi, larengeal bilgisayarlı tomografi ve larengeal elektromiyografi kullanılır. Bu yazıda, transözofageal ekokardiyografiden sonra ses kısıklığı olan 26 yaşında bir kadın hasta sunuldu. Eşlik eden AD ve vokal proses kırığı tanısıyla kapalı redüksiyon uygulandı. Üst solunum yolu ve sindirim sisteminde enstrüman kullanılan ve özellikle AD tanısı konulup redüksiyon işlemlerine yanıt vermeyen tüm hastalarda kapalı redüksiyon düşünülmelidir. Anahtar sözcükler: Aritenoid dislokasyonu; aritenoid sublüksasyonu; entübasyon travması; vokal kord hareketi; ses iyileşmesi. ABSTR ACT Arytenoid dislocation (AD) is a rare condition that may occur secondary to laryngeal trauma. Fiberoptic laryngoscopy, laryngeal computed tomography, and laryngeal electromyography are used to diagnose vocal process fracture in conjunction with AD. In this article, we report a 26-yearold female patient with hoarseness after transesophageal echocardiography. With the diagnosis of concomitant AD and vocal process fracture, closed reduction was performed. Closed reduction should be considered for all patients in whom instruments have been used in the upper aerodigestive tract and particularly who are diagnosed as AD and non-responsive to reduction procedures.

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Section: Discussioncontrasting

confidence: 68%

Iatrogenic vocal process fracture and arytenoid dislocation caused by transesophageal echocardiography

Binnetoğlu¹

2016

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“…Arytenoid dislocation is likely underidentified in the treatment-seeking population, in part owing to its clinical similarity to RLN paralysis. 2,4,6,10 Both disorders result in vocal fold immobility, so unless there is a strong clinical suspicion of cricoarytenoid joint trauma and/or EMG evidence of intact RLN function, arytenoid dislocation may not be considered as a probable diagnosis at initial presentation. Of note, arytenoid malrotation may also occur in the congenitally asymmetric larynx: 20 as such, this should be considered in the differential diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…This observation has been made in previous studies and suggests concomitant neuropathy and/or post-injury muscle fibrosis. 2,4,10 Overall, it appears that high diagnostic confidence requires identifying arytenoid immobility and positional asymmetry, subtle dynamic features (residual cuneiform motion 12 and an absent jostle sign 10 ), normal motor unit recruitment on laryngeal EMG (in most, but not all, cases), and evidence of dislocation on palpation, particularly in patients with a positive history of recent intubation or external laryngeal trauma. Given the relationship between early surgical intervention and favorable clinical outcomes, seen in both our dataset and earlier reports, 2,3,8 it is imperative that patients with a clinical history suggesting possible cricoarytenoid joint trauma undergo a rapid and multifaceted workup.…”

Section: Discussionmentioning

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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“…Conservative management including voice therapy can be helpful in treating arytenoid cartilage dislocation, and surgical correction of the dislocated arytenoid cartilage should be considered in cases not showing improvement. According to a previous study reporting dislocated arytenoid cartilage in 11 patients, 2 out of 5 patients who refused surgery recovered spontaneously [10]. Although spontaneous reduction is rare, inspiratory stridor improved spontaneously in this case.…”

Section: Discussionmentioning

confidence: 47%

Incidental Diagnosis of Pediatric Arytenoid Cartilage Dislocation During Videofluoroscopic Swallowing Study: A Case Report

Lee

Park

et al. 2020

Ann Rehabil Med

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Arytenoid cartilage dislocation is one of the most common mechanical causes of vocal fold immobility. The most common etiologies are intubation and external trauma, but its incidence is lower than 0.1%. Its symptoms include dysphonia, vocal fatigue, loss of vocal control, breathiness, odynophagia, dysphagia, dyspnea, and cough. Although there are some reports of arytenoid cartilage dislocation in adults, there are only few reports on its occurrence in children. It is particularly difficult to detect the symptoms of arytenoid cartilage dislocation in uncooperative pediatric patients with brain lesions without verbal output or voluntary expression. We report a case of arytenoid cartilage dislocation with incidental findings in a videofluoroscopic swallowing study performed to evaluate the swallowing function.

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Pediatric Arytenoid Dislocation: Diagnosis and Treatment

Cited by 13 publications

References 32 publications

Iatrogenic vocal process fracture and arytenoid dislocation caused by transesophageal echocardiography

Iatrogenic vocal process fracture and arytenoid dislocation caused by transesophageal echocardiography

Clinical Features and Surgical Outcomes Following Closed Reduction of Arytenoid Dislocation

Incidental Diagnosis of Pediatric Arytenoid Cartilage Dislocation During Videofluoroscopic Swallowing Study: A Case Report

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