Arytenoid Dislocation After Intubation
Arytenoid dislocation is displacement of the arytenoid cartilage from the cricoarytenoid joint, most often after intubation, extubation or blind device insertion. It presents with hoarseness and impaired cord mobility, and can be mistaken for recurrent laryngeal nerve palsy.
Epidemiology. Rare (about 0.01% to 0.1% of intubations), but under diagnosed. Left arytenoid injury is more frequent with right handed laryngoscopy. Anterior dislocation is more common than posterior.
Risk factors. Difficult or traumatic intubation, blind techniques (airway device insertion, blind tube exchange), self-extubation with inflated cuff, large tube, rheumatoid arthritis, connective tissue disease, prolonged intubation and Cormack-Lehane grade 3 or 4 views.
Pathophysiology.
Shear force against the arytenoid or cuff traction while the cuff is inflated displaces the arytenoid anteriorly (anterior) or posteriorly. Joint capsule disruption and haemarthrosis fix the cord in a paramedian or lateral position.
