eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Laryngology

Arytenoid Dislocation: Follow-up

Author: Joshua S Schindler, MD, Assistant Professor, Department of Otolaryngology, Oregon Health and Science University
Coauthor(s): Yvette V Leslie, MD, Instructor, Department of Otolaryngology, Vanderbilt University Medical Center
Contributor Information and Disclosures

Updated: Jan 29, 2007

Outcome and Prognosis

Early diagnosis and intervention is the best hope for a favorable outcome in the treatment of arytenoid subluxation (AS).

Some patients are able to compensate for the immobile vocal fold and return to near-normal voice quality without surgical intervention. However, most patients require either endoscopic reduction in the early period or medialization procedures in the late period to achieve subjective and objective improvement in voice quality. Outcomes for both procedures have been favorable, although not uniformly successful.

Future and Controversies

Arytenoid subluxation (AS) continues to be a rare, but challenging, problem for the laryngologist. Future management of AS will be directed toward developing more effective means of restoring cricoarytenoid joint structure and mobility, thereby improving phonatory outcomes for patients with this injury. Newer concepts that may add more treatment options for patients with AS are evolving.

The use of botulinum toxin as an adjunct to endoscopic reduction for anteromedial AS has been reported in a recent study. The study proposes that reduction of the arytenoid alone often fails because the surgeon cannot control unbalanced forces placed on the arytenoid by the intrinsic laryngeal musculature. Injection of botulinum toxin into the laryngeal adductor muscles on the affected side weakens these forces and allows the arytenoid to remain in the reduced position. Ten patients were studied, and results were favorable.

Some controversy exists in the literature over the timing of endoscopic reduction. One retrospective series reported favorable voice outcomes in patients who had endoscopic reduction as long as 1 year following injury. This finding challenges the dictum that medialization techniques are the best intervention for late treatment of AS. However, the overall consensus seems to be that, beyond 1 month following injury, the best voice outcomes will likely be obtained using medialization.

 


More on Arytenoid Dislocation

Overview: Arytenoid Dislocation
Workup: Arytenoid Dislocation
Treatment: Arytenoid Dislocation
Follow-up: Arytenoid Dislocation
References
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References

  1. Alexander AE Jr, Lyons GD, Fazekas-May MA, et al. Utility of helical computed tomography in the study of arytenoid dislocation and arytenoid subluxation. Ann Otol Rhinol Laryngol. Dec 1997;106(12):1020-3. [Medline].

  2. Hoffman HT, Brunberg JA, Winter P, et al. Arytenoid subluxation: diagnosis and treatment. Ann Otol Rhinol Laryngol. Jan 1991;100(1):1-9. [Medline].

  3. Paulsen FP, Rudert HH, Tillmann BN. New insights into the pathomechanism of postintubation arytenoid subluxation. Anesthesiology. Sep 1999;91(3):659-66. [Medline].

  4. Paulsen FP, Rudert HH, Tillmann BN. New insights into the pathomechanism of postintubation arytenoid subluxation. Anesthesiology. Sep 1999;91(3):659-66. [Medline].

  5. Rontal E, Rontal M. Botulinum toxin as an adjunct for the treatment of acute anteromedial arytenoid dislocation. Laryngoscope. Jan 1999;109(1):164-6. [Medline].

  6. Rontal E, Rontal M, Silverman B, Kileny PR. The clinical differentiation between vocal cord paralysis and vocal cord fixation using electromyography. Laryngoscope. Feb 1993;103(2):133-7. [Medline].

  7. Rubin AD, Hawkshaw MJ, Moyer CA, et al. Arytenoid cartilage dislocation: a 20-year experience. J Voice. Dec 2005;19(4):687-701. [Medline].

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

  9. Schroeder U, Motzko M, Wittekindt C, Eckel HE. Hoarseness after laryngeal blunt trauma: a differential diagnosis between an injury to the external branch of the superior laryngeal nerve and an arytenoid subluxation. A case report and literature review. Eur Arch Otorhinolaryngol. Jul 2003;260(6):304-7. [Medline].

  10. Schroeder U, Motzko M, Wittekindt C, Eckel HE. Hoarseness after laryngeal blunt trauma: a differential diagnosis between an injury to the external branch of the superior laryngeal nerve and an arytenoid subluxation. A case report and literature review. Eur Arch Otorhinolaryngol. Jul 2003;260(6):304-7. [Medline].

  11. Talmi YP, Wolf M, Bar-Ziv J, et al. Postintubation arytenoid subluxation. Ann Otol Rhinol Laryngol. May 1996;105(5):384-90. [Medline].

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Further Reading

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Keywords

arytenoid dislocation, arytenoid subluxation, AS, fracture, disarticulation, laryngeal injury, larynx injury, upper aerodigestive tract instrumentation, cricoarytenoid joint disruption, cricoarytenoid joint dislocation, laryngeal trauma, larynx trauma, endotracheal intubation complications, upper airway instrumentation, vocal fold paralysis, intubation trauma

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Contributor Information and Disclosures

Author

Joshua S Schindler, MD, Assistant Professor, Department of Otolaryngology, Oregon Health and Science University
Joshua S Schindler, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Otolaryngology-Head and Neck Surgery
Disclosure: Nothing to disclose.

Coauthor(s)

Yvette V Leslie, MD, Instructor, Department of Otolaryngology, Vanderbilt University Medical Center
Yvette V Leslie, MD is a member of the following medical societies: American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, and National Medical Association
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: Nothing to disclose.

Managing Editor

Dominique Dorion, MD, MSc, FRCSC, Program Director and Division Chair, Professor of Surgery, Division of Otolaryngology, University of Sherbrooke, Canada
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: Advanced Headache Intervention Consulting fee Consulting; Covidien Corp Consulting fee Consulting

 
 
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