Skip to main content
SpringerLink
Log in

Current management of arytenoid sub-luxation and dislocation

  • Review Article
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

To review the current management of arytenoid subluxation/dislocation (AS/AD) focusing on diagnostic, therapeutic, and prognostic controversies.

Methods

The international literature of the last 20 years has been considered. After the application of inclusion criteria, 20 studies were selected (471 AS/AD cases in total).

Results

All the included investigations were retrospective case series. AS/AD was often iatrogenic occurring at least in 0.01% of patients undergone endo-tracheal intubation. The most common symptom was persistent hoarseness. The diagnosis was made by video-laryngoscopy and neck computed tomography in most reports, while some used also laryngeal electromyography. Laryngeal electromyography was fundamental to rule out unilateral vocal fold paralysis, the main differential diagnosis. The surgical relocation of AS/AD under general or local anesthesia was achieved in about 80% of patients.

Conclusion

AS/AD is a mechanical disorder of the larynx that can be successfully treated if promptly diagnosed. Clinical trials and multi-centric studies are necessary to set management guidelines.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Wang Z, Liu Q (2002) A comparative study on the close reduction of arytenoid dislocation under indirect and direct laryngoscope. J Huazhong Univ Sci Technol Med Sci 22(4):375–377. https://doi.org/10.1007/bf02896791

    Article  CAS  Google Scholar 

  2. Rubin AD, Hawkshaw MJ, Moyer CA, Dean CM, Sataloff RT (2005) Arytenoid cartilage dislocation: a 20-year experience. J Voice 19(4):687–701. https://doi.org/10.1016/j.jvoice.2004.11.002

    Article  PubMed  Google Scholar 

  3. Hiramatsu H, Tokashiki R, Kitamura M, Motohashi R, Tsukahara K, Suzuki M (2010) New approach to diagnose arytenoid dislocation and subluxation using three-dimensional computed tomography. Eur Arch Otorhinolaryngol 267(12):1893–1903. https://doi.org/10.1007/s00405-010-1300-5(Epub 2010 Jun 12)

    Article  PubMed  Google Scholar 

  4. Leelamanit V, Sinkijcharoenchai W (2012) A promising new technique for closed reduction of arytenoid dislocation. J Laryngol Otol 126(2):168–174. https://doi.org/10.1017/S002221511100226X(Epub 2011 Dec 15)

    Article  PubMed  CAS  Google Scholar 

  5. Lee DH, Yoon TM, Lee JK, Lim SC (2013) Treatment outcomes of closed reduction of arytenoid dislocation. Acta Otolaryngol 133(5):518–522. https://doi.org/10.3109/00016489.2012.758387(Epub 2013 Jan 28)

    Article  PubMed  Google Scholar 

  6. Mallon AS, Portnoy JE, Landrum T, Sataloff RT (2014) Pediatric arytenoid dislocation: diagnosis and treatment. J Voice 28(1):115–122. https://doi.org/10.1016/j.jvoice.2013.08.016(Epub 2013 Oct 8)

    Article  PubMed  Google Scholar 

  7. Teng Y, Wang HE, Lin Z (2014) Arytenoid cartilage dislocation from external blunt laryngeal trauma: evaluation and therapy without laryngeal electromyography. Med Sci Monit 20:1496–1502. https://doi.org/10.12659/MSM.890530

    Article  PubMed  PubMed Central  Google Scholar 

  8. Lee SW, Park KN, Welham NV (2014) Clinical features and surgical outcomes following closed reduction of arytenoid dislocation. JAMA Otolaryngol Head Neck Surg 140(11):1045–1050. https://doi.org/10.1001/jamaoto.2014.2060

    Article  PubMed  PubMed Central  Google Scholar 

  9. Shen L, Wang WT, Yu XR, Zhang XH, Huang YG (2014) Evaluation of risk factors for arytenoid dislocation after endotracheal intubation: a retrospective case-control study. Chin Med Sci J 29(4):221–224. https://doi.org/10.1016/s1001-9294(14)60074-2

    Article  PubMed  CAS  Google Scholar 

  10. Lee DH, Yoon TM, Lee JK, Lim SC (2015) Clinical characteristics of arytenoid dislocation after endotracheal intubation. J Craniofac Surg 26(4):1358–1360. https://doi.org/10.1097/SCS.0000000000001749

    Article  PubMed  Google Scholar 

  11. Tan PH, Hung KC, Hsieh SW, Chen TB, Liu PH, Chen WH (2016) Large-bore calibrating orogastric tube and arytenoid dislocation: a retrospective study. Br J Anaesth 116(2):296–298. https://doi.org/10.1093/bja/aev463

    Article  PubMed  Google Scholar 

  12. Cao L, Wu X, Mao W, Hayes C, Wei C (2016) Closed reduction for arytenoid dislocation under local anesthesia. Acta Otolaryngol 136(8):812–818. https://doi.org/10.3109/00016489.2016.1157267(Epub 2016 Mar 22)

    Article  PubMed  CAS  Google Scholar 

  13. Lou Z, Lin Z (2017) The appropriate time for closed reduction using local anesthesia in arytenoid dislocation caused by intubation: a clinical research. Acta Otolaryngol 137(3):331–336. https://doi.org/10.1080/00016489.2016.1230276(Epub 2016 Sep 22)

    Article  PubMed  Google Scholar 

  14. Tsuru S, Wakimoto M, Iritakenishi T, Ogawa M, Hayashi Y (2017) Cardiovascular operation: a significant risk factor of arytenoid cartilage dislocation/subluxation after anesthesia. Ann Card Anaesth 20(3):309–312. https://doi.org/10.4103/aca.ACA_71_17

    Article  PubMed  PubMed Central  Google Scholar 

  15. Lou Z, Yu X, Li Y, Duan H, Zhang P, Lin Z (2018) BMI may be the risk factor for arytenoid dislocation caused by endotracheal intubation: a retrospective case-control study. J Voice 32(2):221–225. https://doi.org/10.1016/j.jvoice.2017.05.010(Epub 2017 Jun 7)

    Article  PubMed  Google Scholar 

  16. Wu L, Shen L, Zhang Y, Zhang X, Huang Y (2018) Association between the use of a stylet in endotracheal intubation and postoperative arytenoid dislocation: a case–control study. BMC Anesthesiol 18(1):59. https://doi.org/10.1186/s12871-018-0521-9

    Article  PubMed  PubMed Central  Google Scholar 

  17. Hung KC, Chen YT, Chen JY, Kuo CY, Wu SC, Chiang MH, Lan KM, Wang LK, Sun CK (2019) Clinical characteristics of arytenoid dislocation in patients undergoing bariatric/metabolic surgery: a STROBE-complaint retrospective study. Medicine (Baltimore) 98(17):e15318. https://doi.org/10.1097/MD.0000000000015318

    Article  Google Scholar 

  18. Xu X, Wang Y, Wang J, Reiss JF, Zhou L, Jiang JJ, Zhuang P (2019) Quantitative measurement of the three-dimensional structure of the vocal folds and its application in identifying the type of cricoarytenoid joint dislocation. J Voice 33(5):611–619. https://doi.org/10.1016/j.jvoice.2018.02.024(Epub 2018 Aug 23)

    Article  PubMed  Google Scholar 

  19. Wu X, Mao W, Zhang J, Wei C (2019) Treatment outcomes of arytenoid dislocation by closed reduction: a multidimensional evaluation. J Voice. https://doi.org/10.1016/j.jvoice.2019.10.010

    Article  PubMed  Google Scholar 

  20. Zheng T, Lou Z, Li X, Teng Y, Li Y, Lin X, Lin Z (2020) Regularity of voice recovery and arytenoid motion after closed reduction in patients with arytenoid dislocation: a self-controlled clinical study. Acta Otolaryngol 140(1):72–78. https://doi.org/10.1080/00016489.2019.1691745(Epub 2019 Nov 25)

    Article  PubMed  Google Scholar 

  21. https://www.cebm.net/2016/05/ocebm-levels-of-evidence/. Accessed 21 Apr 2020

  22. Nerurkar N, Chhapola S (2012) Arytenoid subluxation after a bout of coughing: a rare case. Am J Otolaryngol 33(2):275–278. https://doi.org/10.1016/j.amjoto.2011.07.001(Epub 2011 Aug 15)

    Article  PubMed  Google Scholar 

  23. Friedman AD, Kobler JB, Landau-Zemer T, Barbu AM, Burns JA (2012) High-force simulated intubation fails to dislocate cricoarytenoid joint in ex vivo human larynges. Ann Otol Rhinol Laryngol 121(11):746–753. https://doi.org/10.1177/000348941212101108

    Article  PubMed  Google Scholar 

  24. Gallet P, Nguyen DT, Toussaint B, Rumeau C (2019) Spontaneous arytenoid dislocation and crico-arytenoid instability. Eur Ann Otorhinolaryngol Head Neck Dis 136(4):307–308. https://doi.org/10.1016/j.anorl.2019.02.018(Epub 2019 Mar 23)

    Article  PubMed  CAS  Google Scholar 

  25. Chowdhury F, Siddiqui U, Tsui BC, El-Hakim H (2014) Postintubation arytenoid dislocation/subluxation in CHARGE infants. Paediatr Anaesth 24(2):225–227. https://doi.org/10.1111/pan.12288

    Article  PubMed  Google Scholar 

  26. Yamanaka H, Hayashi Y, Watanabe Y, Uematu H, Mashimo T (2009) Prolonged hoarseness and arytenoid cartilage dislocation after tracheal intubation. Br J Anaesth 103(3):452–455. https://doi.org/10.1093/bja/aep169(Epub 2009 Jun)

    Article  PubMed  CAS  Google Scholar 

  27. Inoue S, Abe R, Tanaka Y, Kawaguchi M (2015) Tracheal intubation by trainees does not alter the incidence or duration of postoperative sore throat and hoarseness: a teaching hospital-based propensity score analysis. Br J Anaesth 115(3):463–469. https://doi.org/10.1093/bja/aev234(Epub 2015 Aug 4)

    Article  PubMed  CAS  Google Scholar 

  28. Skoretz SA, Flowers HL, Martino R (2010) The incidence of dysphagia following endotracheal intubation: a systematic review. Chest 137(3):665–673. https://doi.org/10.1378/chest.09-1823.Review

    Article  PubMed  Google Scholar 

  29. Ysunza-Rivera A, Landeros L, Pamplona MC, Silva-Rojas JA, Prado-Calleros HM, Fajardo-Dolci GE (2008) The role of electromyography in cases of vocal cord paralysis. Gac Med Mex 144(4):303–308

    PubMed  Google Scholar 

  30. Sataloff RT, Praneetvatakul P, Heuer RJ, Hawkshaw MJ, Heman-Ackah YD, Schneider SM, Mandel S (2010) Laryngeal electromyography: clinical application. J Voice 24(2):228–234. https://doi.org/10.1016/j.jvoice.2008.08.005(Epub 2008 Dec 25)

    Article  PubMed  Google Scholar 

  31. Lovato A, Barillari MR, Giacomelli L, Gamberini L, de Filippis C (2019) Predicting the outcome of unilateral vocal fold paralysis: a multivariate discriminating model including grade of dysphonia, jitter, shimmer, and voice handicap index-10. Ann Otol Rhinol Laryngol 128(5):447–452

    Article  PubMed  Google Scholar 

  32. Norris BK, Schweinfurth JM (2011) Arytenoid dislocation: an analysis of the contemporary literature. Laryngoscope 121(1):142–146. https://doi.org/10.1002/lary.21276(Review)

    Article  PubMed  Google Scholar 

  33. Tan V, Seevanayagam S (2009) Arytenoid subluxation after a difficult intubation treated successfully with voice therapy. Anaesth Intensive Care 37(5):843–846

    Article  CAS  PubMed  Google Scholar 

  34. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien-Dindo classification of surgical complications: 5-year experience. Ann Surg 250(2):187–196. https://doi.org/10.1097/SLA.0b013e3181b13ca2

    Article  PubMed  Google Scholar 

  35. Quick CA, Merwin GE (1978) Arytenoid dislocation. Arch Otolaryngol 104(5):267–270. https://doi.org/10.1001/archotol.1978.00790050033007

    Article  PubMed  CAS  Google Scholar 

  36. Lovato A, De Colle W, Giacomelli L, Piacente A, Righetto L, Marioni G, de Filippis C (2016) Multi-dimensional voice program (MDVP) vs praat for assessing euphonic subjects: a preliminary study on the gender-discriminating power of acoustic analysis software. J Voice 30(6):765.e1–765.e5

    Article  Google Scholar 

  37. Lovato A, de Filippis C (2018) Comment on "Using innovative acoustic analysis to predict the postoperative outcomes of unilateral vocal fold paralysis". Biomed Res Int 2018:6269593

    Article  PubMed  PubMed Central  Google Scholar 

  38. Lovato A, Bonora C, Genovese E, Amato C, Maiolino L, de Filippis C (2020) A panel of jitter/shimmer may identify functional dysphonia at risk of failure after speech therapy. Am J Otolaryngol. https://doi.org/10.1016/j.amjoto.2020.102455

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Audiology Unit at Treviso Hospital, Department of Neuroscience DNS, University of Padova, Piazzale Ospedale 1, 31100, Treviso, Italy

    Andrea Frosolini, Cosimo de Filippis & Andrea Lovato

  2. Otolaryngology Unit, Department of Neuroscience DNS, University of Padova, Padova, Italy

    Gino Marioni

  3. ENT Section, Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, University of Catania, Catania, Italy

    Luigi Maiolino

Authors
  1. Andrea Frosolini
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gino Marioni
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Luigi Maiolino
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Cosimo de Filippis
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Andrea Lovato
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Andrea Lovato.

Ethics declarations

Conflict of interest

The authors declare that they have no confict of interest.

Human and animal rights

This article does not contain any studies with human participants or animals performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Frosolini, A., Marioni, G., Maiolino, L. et al. Current management of arytenoid sub-luxation and dislocation. Eur Arch Otorhinolaryngol 277, 2977–2986 (2020). https://doi.org/10.1007/s00405-020-06042-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-020-06042-3

Keywords

Search

Navigation