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World Journal of Clinical Cases May 2022Arytenoid cartilage dislocation is a rare and often overlooked complication of tracheal intubation or blunt laryngeal trauma. The most common symptom is persistent...
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 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.
PubMed: 35801012
DOI: 10.12998/wjcc.v10.i15.5119 -
The Journal of Veterinary Medical... Oct 2020A 76-day-old Japanese Black calf presented with severe stridor, resenting palpation of the laryngeal region. Endoscopic examination revealed an expansile process...
A 76-day-old Japanese Black calf presented with severe stridor, resenting palpation of the laryngeal region. Endoscopic examination revealed an expansile process restricting the esophageal and tracheal lumina caudal to the arytenoid cartilage, hyperemia and edema of the pharyngeal mucosa, right arytenoid cartilage swelling and displacement, and marked airway obstruction. The absence of an endotracheal wall abnormality impeded a definitive diagnosis. Computed tomography (CT) revealed a mass (CT value: 40-45 HU) caudal to the arytenoid cartilage, causing tracheal stenosis and esophageal displacement. The presence of gas in the mass suggested the presence of an abscess. Diagnosis of deep retropharyngeal lesions by conventional endoscopic and ultrasonographic examinations may be challenging; CT can then provide more comprehensive diagnostic information on a lesion.
Topics: Abscess; Airway Obstruction; Animals; Arytenoid Cartilage; Cattle; Cattle Diseases; Larynx; Tomography, X-Ray Computed
PubMed: 32879155
DOI: 10.1292/jvms.20-0384 -
Reports of Practical Oncology and... 2019The aim of the study was to assess the accuracy of radiological diagnosis of laryngeal cartilage infiltration by histopathological examination of laryngeal specimen...
AIM
The aim of the study was to assess the accuracy of radiological diagnosis of laryngeal cartilage infiltration by histopathological examination of laryngeal specimen after total laryngectomy.
BACKGROUND
Despite the development of new medical technologies and significant clinical advances allowing early diagnosis and treatment of laryngeal cancer, mortality is still on the rise. Neoplastic infiltration of the laryngeal cartilages is the most common source of error in the assessment of cancer staging. Furthermore, cartilage invasion is listed as a contraindication to partial surgical techniques as well as radiotherapy.
MATERIALS AND METHODS
The study was carried out on 21 larynges following total laryngectomy. Before taking the decision to perform surgery, high-resolution CT scans were performed in all cases. An extended histopathological examination was conducted using a unique vertical cross-section of the whole larynx.
RESULTS
Pathology reported 2 cases of arytenoid cartilage invasion, 5 cases of cricoid cartilage invasion, 12 cases of thyroid cartilage penetration, 1 case of internal cortex invasion and 9 cases of extra-laryngeal spread. CT imaging identified 8 of 13 cases (61.5%) of pathologically proven invasion of thyroid cartilage and only 2 cases (2/9, 22%) of extra-laryngeal spread. According to CT results, arytenoid cartilage invasion was correctly identified in 2 cases, cricoid cartilage invasion in 4 (4/5, 80%). The positive predictive values for thyroid, cricoid and arytenoid cartilage invasion and penetration were 80%, 66.7% and 50%, respectively. In case of pre-laryngeal spread the positive predictive value was 100%.
CONCLUSION
Despite increasingly advanced methods involved in the diagnosis of laryngeal cancer, many discrepancies may be observed between the radiological and histopathological assessments. CT imaging has limitations especially in thyroid cartilage penetration and extra-laryngeal spread assessment in advanced laryngeal cancer cases. An extended histopathological examination, involving vertical cross-sections of the whole larynx is a very precise study that allows a precise determination of local cancer staging (T).
PubMed: 31388338
DOI: 10.1016/j.rpor.2019.07.002 -
Veterinary Surgery : VS Feb 2023To document variations in the application of equine prosthetic laryngoplasty among equine surgeons.
OBJECTIVE
To document variations in the application of equine prosthetic laryngoplasty among equine surgeons.
STUDY DESIGN
Cross-sectional survey.
SAMPLE POPULATION
Six hundred and seventy-eight equine surgeons performing prosthetic laryngoplasty.
METHODS
An online questionnaire was sent to equine surgeons, including diplomates of the American College of Veterinary Surgeons and European College of Veterinary Surgeons. Questions focused on participant profile, surgical technique, antimicrobial therapy, and concurrent procedures. Descriptive statistical analysis was performed on the survey output.
RESULTS
Complete responses were received from 128/678 individuals, mostly from experienced surgeons. Most participants used 2 prostheses (106/128, 82.8%) and a single loop was the most common method used to anchor the prosthesis in the cricoid (95/128, 74.2%) and arytenoid (125/128, 97.7%) cartilages. Use of general anesthesia was common, although 46/128 (35.9%) participants now performed most laryngoplasty surgery with standing sedation. The material used as a prosthesis varied among surgeons, although participants typically aimed to achieve grade 2 intraoperative arytenoid abduction. Participants most commonly administered perioperative systemic antimicrobial therapy for 1-3 days (57/128, 44.5%) and 48/128 (37.5%) used local antimicrobial therapy.
CONCLUSION
Most surgeons performed laryngoplasty with 2 prostheses, a single loop construct at the muscular process of the arytenoid cartilage and systemic antimicrobial therapy. There was variation in the preferred method of surgical restraint, prosthesis material selection, and use of local antimicrobial therapy.
CLINICAL SIGNIFICANCE
Long-established techniques remain popular in clinical practice despite evidence that variations offer advantages, particularly in relation to biomechanics. Other factors are also likely to influence technique selection in a clinical context.
Topics: Animals; Humans; Arytenoid Cartilage; Cross-Sectional Studies; Horse Diseases; Horses; Laryngoplasty; Larynx; Surgeons
PubMed: 36420588
DOI: 10.1111/vsu.13913 -
Movement Disorders : Official Journal... Dec 2020Multiple system atrophy (MSA) is a rare neurodegenerative disorder, and its parkinsonian variant can be difficult to delineate from Parkinson's disease (PD). Despite...
BACKGROUND
Multiple system atrophy (MSA) is a rare neurodegenerative disorder, and its parkinsonian variant can be difficult to delineate from Parkinson's disease (PD). Despite laryngeal dysfunction being associated with decreased life expectancy and quality of life, systematic assessments of laryngeal dysfunction in large cohorts are missing.
OBJECTIVES
The objective of this study was to systematically assess laryngeal dysfunction in MSA and PD and identify laryngeal symptoms that allow for differentiating MSA from PD.
METHODS
Patients with probable or possible MSA underwent flexible endoscopic evaluation of swallowing performing a systematic task protocol. Findings were compared with an age-matched PD cohort.
RESULTS
A total of 57 patients with MSA (64 [59-71] years; 35 women) were included, and task assessments during endoscopic examination compared with 57 patients with PD (67 [60-73]; 28 women). Patients with MSA had a shorter disease duration (4 [3-5] years vs 7 [5-10]; P < 0.0001) and higher disease severity (Hoehn & Yahr stage 4 [3-4] vs 3 [2-4]; P < 0.0001). Of the patients with MSA, 43.9% showed clinically overt laryngeal dysfunction with inspiratory stridor. During endoscopic task assessment, however, 93% of patients with MSA demonstrated laryngeal dysfunction in contrast with only 1.8% of patients with PD (P < 0.0001). Irregular arytenoid cartilages movements were present in 91.2% of patients with MSA, but in no patients with PD (P < 0.0001). Further findings included vocal fold motion impairment (75.4%), paradoxical vocal fold motion (33.3%), and vocal fold fixation (19.3%). One patient with PD showed vocal fold motion impairment.
CONCLUSION
Laryngeal movement disorders are highly prevalent in patients with MSA when assessed by a specific task protocol despite the lack of overt clinical symptoms. Our data suggest that irregular arytenoid cartilage movements could be used as a clinical marker to delineate MSA from PD with a specificity of 1.0 and sensitivity 0.9. © 2020 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
Topics: Female; Humans; Laryngeal Diseases; Multiple System Atrophy; Parkinson Disease; Quality of Life; Respiratory Sounds
PubMed: 32757231
DOI: 10.1002/mds.28220 -
Beijing Da Xue Xue Bao. Yi Xue Ban =... Sep 2020To assess the incidence of postoperative vocal cord immobility in patients following endotracheal intubation underwent general anesthesia.
OBJECTIVE
To assess the incidence of postoperative vocal cord immobility in patients following endotracheal intubation underwent general anesthesia.
METHODS
We retrospectively enrolled patients who underwent surgical procedures with endotracheal intubation under general anesthesia from January 2014 to December 2018 in Peking University First Hospital. Demographic and treatment data were obtained for patients with hoarseness and vocal cord fixation. The incidence of postoperative hoarseness and vocal cord fixation were presented and clinical outcomes were further analyzed.
RESULTS
A total of 85 998 patients following tracheal intubation and general anesthesia were enrolled in this study. Hoarseness was observed in 222 (0.26%) patients postoperatively. Sixteen patients (73%) were accomplished with symptoms of choking on water, dysphonia and sore throat. Twenty-nine patients with persistent hoarseness on the third postoperative day needed further treatment by otolaryngologists. Among them, seven patients had pharyngolaryngitis and twenty-two patients (0.026%) were demonstrated postoperative vocal cord immobility. There were seventeen patients (77%) with left-side vocal cord fixation and five patients (23%) with right-side vocal cord fixation. Nine patients were identified with arytenoid dislocation. Seven patients had left vocal cord fixation and two patients had right-side vocal cord fixation. Seven patients were intubated under the guidance of visual laryngoscope. One patient was confirmed difficult airway and intubated with light wand. One patient was inserted with laryngeal mask airway. One patient was suspected to have hoarseness caused by gastric tube before anesthesia. One patient showed simultaneously left recurrent laryngeal nerve abnormality on laryngeal electromyography result. The symptom of hoarseness ranged between 6 and 31 days. Three patients underwent closed reduction under local anesthesia and one patient demonstrated spontaneous recovery. Among the remaining thirteen patients with vocal cord immobility, two patients were demonstrated vocal cord paralysis. Eleven patients underwent neck surgery, thyroid surgery and cardiothoracic surgery and further examinations including laryn-geal electromyography and computed tomography help to determine the diagnosis were not performed. All patients were treated with inhaled corticosteroid conservatively. Five patients had significant improvement of symptom and almost regained normal voice. One patient had slight improvement and sixteen patients were not relieved before discharge.
CONCLUSION
Patients with hoarseness and vocal fold immobility after endotracheal intubation should be treated properly and immediately.
Topics: Arytenoid Cartilage; Hoarseness; Humans; Intubation, Intratracheal; Retrospective Studies; Vocal Cords
PubMed: 33879908
DOI: 10.19723/j.issn.1671-167X.2021.02.018 -
European Archives of... Sep 2023To define the localization and configuration of the elastic fibers of the cricoarytenoid ligament (CAL) and their relationship with the cricoarytenoid joint (CAJ)...
PURPOSE
To define the localization and configuration of the elastic fibers of the cricoarytenoid ligament (CAL) and their relationship with the cricoarytenoid joint (CAJ) capsule.
METHODS
Twenty-four CAJs from twelve cadavers were analyzed using Verhoeff-Van Gieson staining, and immunohistochemistry methods. This is a prospective study.
RESULTS
The CAL was classified into two parts: an extra-capsular anterior-CAL and an intra-capsular posterior-CAL. The both parts contained rich elastic fibers. The elastic fibers of the anterior-CAL were orientated in both anterior-posterior and superior-inferior directions and under a relaxation status, whereas the elastic fibers of the posterior-CAL were arranged in a lateral-medial direction and under a taut status.
CONCLUSIONS
This study defined the fine configuration of the CAL, particularly its elastic fibers, which may help us to better understand the biomechanics of the CAJ motions, and differential diagnosis of CAJ disorders. The results of the study re-confirm that the P-CAL is the key posterior-lateral passive force to limit the mobility of the muscular process of the arytenoid cartilage and stabilize the CAJ, whereas the A-CAL may protect the CAJ from an over superior-lateral-posterior motion.
LEVEL OF EVIDENCE
H/A.
Topics: Humans; Aged; Arytenoid Cartilage; Elastin; Elastic Tissue; Prospective Studies; Ligaments; Cadaver
PubMed: 37208491
DOI: 10.1007/s00405-023-08003-y -
BMJ Case Reports Dec 2021Laryngeal varices are rare and are usually associated with vocal cord trauma secondary to excessive use of voice. This report is the first documented case of laryngeal...
Laryngeal varices are rare and are usually associated with vocal cord trauma secondary to excessive use of voice. This report is the first documented case of laryngeal varices secondary to thyroid goitre. This is a report of an 83-year-old woman with a known retrosternal goitre chiefly with symptoms of globus. Retrosternal goitre was found to be compressing the pharyngeal venous plexus causing laryngeal venous structures bilaterally to be engorged along the aryepiglottic folds, arytenoids, posterior commissure and extending in to the postcricoid region. The presence of laryngeal varices carries a significant increased risk of haemorrhage. This case presents an atypical presentation of globus and the first reported case in the literature of laryngeal varices secondary to a thyroid goitre.
Topics: Aged, 80 and over; Arytenoid Cartilage; Female; Goiter, Substernal; Humans; Laryngeal Diseases; Larynx; Varicose Veins
PubMed: 34969797
DOI: 10.1136/bcr-2021-246413 -
BMC Anesthesiology Jul 2021Arytenoid dislocation is a rare laryngeal injury that may follow endotracheal intubation. We aimed to determine the incidence and risk factors for arytenoid dislocation...
BACKGROUND
Arytenoid dislocation is a rare laryngeal injury that may follow endotracheal intubation. We aimed to determine the incidence and risk factors for arytenoid dislocation after surgery under general anaesthesia.
METHODS
We reviewed the medical records of patients who underwent operation under general anaesthesia with endotracheal intubation from January 2014 to December 2018. Patients were divided into the non-dislocation and dislocation groups depending on the presence or absence of arytenoid dislocation. Patient, anaesthetic, and surgical factors associated with arytenoid dislocation were determined using Poisson regression analysis.
RESULTS
Among the 25,538 patients enrolled, 33 (0.13%) had arytenoid dislocation, with higher incidence after anterior neck and brain surgery. Patients in the dislocation group were younger (52.6 ± 14.4 vs 58.2 ± 14.2 yrs, P = 0.025), more likely to be female (78.8 vs 56.5%, P = 0.014), and more likely to be intubated by a first-year anaesthesia resident (33.3 vs 18.5%, P = 0.048) compared to those in the non-dislocation group. Patient positions during surgery were significantly different between the groups (P = 0.000). Multivariable Poisson regression identified head-neck positioning (incidence rate ratio [IRR], 3.10; 95% confidence interval [CI], 1.50-6.25, P = 0.002), endotracheal intubation by a first-year anaesthesia resident (IRR, 2.30; 95% CI, 1.07-4.64, P = 0.024), and female (IRR, 3.05; 95% CI, 1.38-7.73, P = 0.010) as risk factors for arytenoid dislocation.
CONCLUSION
This study showed that the incidence of arytenoid dislocation was 0.13%, and that head-neck positioning during surgery, less anaesthetist experience, and female were significantly associated with arytenoid dislocation in patients who underwent surgeries under general anaesthesia with endotracheal intubation.
Topics: Adult; Aged; Anesthesia, General; Arytenoid Cartilage; Female; Head Movements; Humans; Incidence; Intubation, Intratracheal; Joint Dislocations; Male; Middle Aged; Neck; Patient Positioning; Retrospective Studies; Risk Factors
PubMed: 34330223
DOI: 10.1186/s12871-021-01419-1