Spontaneous reposition of a dislocated arytenoid cartilage

Department of Anaesthesiology, University of Ulm, Germany.
BJA British Journal of Anaesthesia (Impact Factor: 4.85). 06/1993; 70(5):591-2. DOI: 10.1093/bja/70.5.591
Source: PubMed


We report a patient suffering from arytenoid cartilage dislocation after difficult trachea/ intubation and the abrupt spontaneous
reposition in the course of severe vomiting 1 month after the operation. Predisposing factors for the unusual reposition are
discussed. (Br. J. Anaesth. 1993; 70: 591–592)

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    ABSTRACT: The cricoarytenoid joints of 12 human adult male and female larynges were studied with regard to the anatomical reasons for arytenoid cartilage dislocation. The specimens were impregnated with curable polymers as a whole and then cut into 600–800 μm sections along different planes. The articulating surface at the upper border of the cricoid lamina revealed a striking extension backward and occasionally even slightly distalward. This may allow the arytenoid cartilage to glide in a posterior direction until it partially looses its contact to the cricoid facet. In physiologic conditions, the arytenoid position is balanced along a sagittal plane between the posterior cricoarytenoid ligament dorsally and the thyroarytenoid muscle ventrally. If one of these structures is damaged, i.e., by medical disease or trauma, the arytenoid cartilage may be pushed easily in the opposite direction. Arytenoid dislocation mainly in a posterior direction is described in literature as a possible complication of endotracheal intubation. Preparatory pharmacological muscle relaxation leads to paralysis of the thyroarytenoid muscle and its ventrally directed traction on the arytenoid cartilage. As the shape of the articulating surfaces, especially the peculiarities of the cricoid facet, even facilitates a dorsally directed movement of the Arytenoid cartilage, it may be easily displaced in a posterior direction during the procedure of endotracheal intubation. © 1994 Wiley-Liss, Inc.
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    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.
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    ABSTRACT: The subglottic regions of 54 human adult male and female larynges were studied with regard to anatomical aspects of postintubational stenosis. Fourteen specimens were impregnated with curable polymers and cut into 600-800 microns sections along different planes. Forty formalin-fixed hemilarynges were dissected. Measurements of the upper cricoid lamina and the thickness of the endocricoid soft tissues were taken for statistical analysis. Immediately beneath the glottis, the upper part of the cricoid lamina consists of two lateral plates with an average angle of 110 degrees. Distally, the cricoid adopts a more and more rounded lumen. At the level of the cricothyroid joint, the definite airway lumen is always laterally narrowed by a prominent thickening of the endocricoid soft tissue. Large amounts of loose connective tissue facilitate the development of edema in case of injury in this region. Dorsally, the submucous stratum is smaller and consists mainly of dense connective tissue. The blood vessels are fixed to the cricoid perichondrium by collagenous fibers. Any pressure applied from the airway lumen will force the vessels against the nonresilient cartilage, resulting in occlusion and ischemia. These pathophysiologic mechanisms are important for the development of early laryngeal damage during endotracheal intubation, possibly resulting in posterior stenosis due to scarring later on.
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