Value of Electromyography in Differential Diagnosis of Laryngeal Joint Injuries after Intubation

Abstract

Laryngeal joint injury or arytenoid dislocation is not an uncommon complication resulting from intubation trauma, and is best evaluated by laryngeal electromyography (EMG) combined with laryngoscopic examinations. Two cases of cricoarytenoid joint injuries after intubation are reported along with laryngeal EMG findings. Early diagnosis of arytenoid dislocation is important for appropriate surgical management and better prognosis. However, the reported cases, because of delayed referrals, showed prolonged cricoarytenoid joint injuries associated with thyroarytenoid muscle denervation or myopathy, and resultant vocal fold immobility. The results of laryngeal EMG in cricoarytenoid joint injuries can be classified into three different patterns: 1) normal recruitment, 2) myopathy, and 3) denervation or reinnervation of the thyroarytenoid muscles. It is particularly valuable to sample different portions of the thyroarytenoid muscles with EMG in order to evaluate different patterns or pathologic changes of the muscles and nerve paralysis.

Isolated bilateral vocal cord paralysis with intermediate syndrome after organophosphate poisoning

“…Normal recruitment pattern of LEMG is most commonly found in arytenoid dislocation (9) and also may appear in a patient with prolonged intubation (10). LEMG findings in our case concurrently revealed neuropathic (denervation or partial denervation) patterns in bilateral thyroarytenoid and cricothyroid muscles.…”

The role of laryngeal electromyography in the diagnosis of vocal fold immobility in children

“…This disorder can be best evaluated by laryngeal EMG combined with laryngoscopic examinations and CT scans. Early diagnosis of arytenoids dislocation is important for appropriate conservative or surgical management and better prognosis [8].…”

Subluxation of the Cricoarytenoid Joint After External Laryngeal Trauma: A Rare Case and Review of the Literature

“…A CT scan of the laryngeal skeleton can reveal changes in the cricoarytenoid joints in addition to changes in other laryngeal structures and is a useful exam to help reach the diagnosis [8]. Laryngeal electromyography (EMG) is a useful tool because it may help to distinguish between cricoarytenoid joint subluxation and vocal palsy [9], as a dislocated arytenoid cartilage would most probably show normal EMG patterns while in case of a vocal cord palsy it would result in pathologic patterns. Despite its important contribution, laryngeal electromyography was used in a minority of cases [5].…”