eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Laryngology

Arytenoid Fixation: Workup

Author: Robert A Buckmire, MD, Associate Professor, Department of Otolaryngology-Head and Neck Surgery, University of North Carolina; Chief, Division of Voice and Swallowing Disorders, Director, University of North Carolina Voice Center
Coauthor(s): Paul C Bryson, MD, Clinical Fellow, Center for Laryngeal Surgery & Voice Rehabilitation, Massachusetts General Hospital, Harvard Medical School
Contributor Information and Disclosures

Updated: May 19, 2009

Workup

Imaging Studies

  • Although CT scanning may help in demonstrating arytenoid dislocation or cartilaginous fracture, the extent of ossification of the laryngeal cartilage and the plane and thickness of the sections limit the sensitivity of CT. In patients in whom the arytenoid is not ossified (ie, children, young adults), CT imaging is relatively unrevealing.
  • Plain radiography of the neck and larynx occasionally reveals evidence of cricoarytenoid (CA) joint pathology. Joint erosion and blurring may demonstrate active arthritis.

Diagnostic Procedures

  • Electromyography of the thyroarytenoid, cricothyroid, and posterior cricoarytenoid (CA) muscles help to clarify the status of laryngeal innervation. In general, a normal pattern of laryngeal-muscle activation and recruitment is expected in a patient with isolated cricoarytenoid (CA) fixation.
  • Videostroboscopy, electromyography, and CT scanning may help to distinguish a fixed cricoarytenoid (CA) joint from an immobile vocal fold of another cause. Of these examinations, videostroboscopy is the most readily available and useful to determine the exact position of the arytenoid, to assess subtle movements, and to determine the relative positions of the vocal folds, aims which may help to narrow the differential diagnoses.
  • Operative direct laryngoscopy is the criterion standard for clinical evaluation of cricoarytenoid (CA) joint mobility.  
    • The recommended technique requires that the patient be under general anesthesia with deep paralysis.
    • In the ideal situation, the patient is in laryngeal suspension, and the examiner uses 1 hand to externally stabilize the larynx while attempting endoscopic manipulation of the arytenoid.
    • This technique is intended to avoid misinterpreting movement of the entire larynx as arytenoid mobility.
    • Surrounding tissues, as well as the arytenoid, should be palpated to determine the presence of scarring or associated lesions.
    • Lateral displacement of 1 arytenoid accompanied by passive medial movement of the other may indicate interarytenoid tethering.
    • Careful attention to the exact placement of the laryngoscope is also important.
    • Placement of the blade too deeply in the laryngeal inlet may artificially restrict motion.
    • Note any associated subglottic stenosis and/or tracheal stenosis at the time of endoscopy.

Histologic Findings

Histologic involvement of the cricoarytenoid (CA) joint was found in 47-78% of patients with rheumatoid arthritis examined on postmortem studies.

Early changes include thickened synovium and cellular hyperplasia with a plasma cell and/or lymphocytic infiltrate. Late changes include effusions originating from the hypertrophied lining leave fibrin deposits within the joint cavity. Progressive alterations lead to destruction of the articular surfaces. The ultimate loss of joint space is secondary to a reparative process laying down vascular, fibrous, and fatty tissue.

More on Arytenoid Fixation

Overview: Arytenoid Fixation
Workup: Arytenoid Fixation
Treatment: Arytenoid Fixation
Follow-up: Arytenoid Fixation
Multimedia: Arytenoid Fixation
References
[ CLOSE WINDOW ]

References

  1. Wang R. Three-dimensional analysis of cricoarytenoid joint motion. Laryngoscope. 1998;4 Pt 2 supp 86:1-17.

  2. Schaefer SD, Close LG, Brown OE. Mobilization of the fixated arytenoid in the stenotic posterior laryngeal commissure. Laryngoscope. Jun 1986;96(6):656-9. [Medline].

  3. Ejnell H, Bake B, Mansson I, et al. New mobilization and laterofixation procedure for cricoarytenoid joint ankylosis in rheumatoid arthritis. Ann Otol Rhinol Laryngol. Sep-Oct 1985;94(5 Pt 1):442-4. [Medline].

  4. Cummings CW, Redd EE, Westra WH, Flint PW. Minimally invasive device to effect vocal fold lateralization. Ann Otol Rhinol Laryngol. Sep 1999;108(9):833-6. [Medline].

  5. Rovo L, Venczel K, Torkos A, Majoros V, Sztano B, Jori J. Endoscopic arytenoid lateropexy for isolated posterior glottic stenosis. Laryngoscope. Sep 2008;118(9):1550-5. [Medline].

  6. Kashima HK. Bilateral vocal fold motion impairment: pathophysiology and management by transverse cordotomy. Ann Otol Rhinol Laryngol. Sep 1991;100(9 Pt 1):717-21. [Medline].

  7. Ossoff RH, Sisson GA, Duncavage JA, Moselle HI, Andrews PE, McMillan WG. Endoscopic laser arytenoidectomy for the treatment of bilateral vocal cord paralysis. Laryngoscope. Oct 1984;94(10):1293-7. [Medline].

  8. Benninger MS, Gillen JB, Altman JS. Changing etiology of vocal fold immobility. Laryngoscope. Sep 1998;108(9):1346-50. [Medline].

  9. Bosley B, Rosen CA, Simpson CB, McMullin BT, Gartner-Schmidt JL. Medial arytenoidectomy versus transverse cordotomy as a treatment for bilateral vocal fold paralysis. Ann Otol Rhinol Laryngol. Dec 2005;114(12):922-6. [Medline].

  10. Bridger MW, Jahn AF, van Nostrand AW. Laryngeal rheumatoid arthritis. Laryngoscope. Feb 1980;90(2):296-303. [Medline].

  11. Bryer D, Rounthwaite FJ. Cricoarytenoid arthritis due to mumps. Laryngoscope. Mar 1973;83(3):372-5. [Medline].

  12. Colman MF, Schwartz I. The effect of vocal cord paralysis on the cricoarytenoid joint. Otolaryngol Head Neck Surg. May-Jun 1981;89(3 Pt 1):419-22. [Medline].

  13. Elsherief S, Elsheikh MN. Endoscopic radiosurgical posterior transverse cordotomy for bilateral median vocal fold immobility. J Laryngol Otol. Mar 2004;118(3):202-6. [Medline].

  14. Gacek M, Gacek RR. Cricoarytenoid joint mobility after chronic vocal cord paralysis. Laryngoscope. Dec 1996;106(12 Pt 1):1528-30. [Medline].

  15. Goodman M, Montgomery W, Minette L. Pathologic findings in gouty cricoarytenoid arthritis. Arch Otolaryngol. Jan 1976;102(1):27-9. [Medline].

  16. Jurik AG, Pedersen U, Noorgard A. Rheumatoid arthritis of the cricoarytenoid joints: a case of laryngeal obstruction due to acute and chronic joint changes. Laryngoscope. Jul 1985;95(7 Pt 1):846-8. [Medline].

  17. Kasperbauer JL. A biomechanical study of the human cricoarytenoid joint. Laryngoscope. Nov 1998;108(11 Pt 1):1704-11. [Medline].

  18. Maragos NE. Arytenoid fixation surgery for the treatment of arytenoid fractures and dislocations. Laryngoscope. May 1999;109(5):834-7. [Medline].

  19. Sataloff RT, Bough ID Jr, Spiegel JR. Arytenoid dislocation: diagnosis and treatment. Laryngoscope. Nov 1994;104(11 Pt 1):1353-61. [Medline].

  20. Simpson GT 2nd, Javaheri A, Janfaza P. Acute cricoarytenoid arthritis: local periarticular steroid injection. Ann Otol Rhinol Laryngol. Nov-Dec 1980;89(6 Pt 1):558-62. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

arytenoid fixation, arytenoid, cricoarytenoid fixation, cricoarytenoid, CA fixation, cricoarytenoid ankylosis, CA ankylosis, arytenoid ankylosis, cricoarytenoid joint fixation, CA joint fixation, cricoarytenoid joint

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Robert A Buckmire, MD, Associate Professor, Department of Otolaryngology-Head and Neck Surgery, University of North Carolina; Chief, Division of Voice and Swallowing Disorders, Director, University of North Carolina Voice Center
Robert A Buckmire, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, and National Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Paul C Bryson, MD, Clinical Fellow, Center for Laryngeal Surgery & Voice Rehabilitation, Massachusetts General Hospital, Harvard Medical School
Paul C Bryson, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, Phi Beta Kappa, and Triological Society
Disclosure: Nothing to disclose.

Medical Editor

John Schweinfurth, MD, Associate Professor, Department of Otolaryngology, University of Mississippi Medical Center
John Schweinfurth, MD is a member of the following medical societies: American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Stephen G Batuello, MD, Consulting Staff, Colorado ENT Specialists
Stephen G Batuello, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Physician Executives, American Medical Association, and Colorado Medical Society
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo  Consulting; Medvoy Ownership interest Management position

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.