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Published on: June 20, 2018
[Modified closed reduction for the arytenoid cartilage dislocation]
1Department of Otorhinolaryngology Head Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otorhinolaryngology Head Neck Surgery, Ministry of Education, Beijing 100730,China.
Objective:
To investigate the clinical characteristics of arytenoid cartilage dislocation and the outcome of modified closed reduction.
Methods:
Sixty-seven patients with vocal fold immobility underwent modified closed reduction under local anesthesia through indirect laryngoscope. During reduction, a right-angled laryngeal forceps was used to hold the superior surface of the affected arytenoids and rotate in posterolateral or anteromedial direction according different situation of dislocation. Fifty-seven patients had previously undergone endotracheal intubation for surgery and 10 patients had nonintubated injury with blunt laryngeal trauma in 6 cases. Clinical characteristics, voice function, procedural skill and therapy outcome of those cases were evaluated.
Results:
All patients complained of persistent hoarseness. Stroboscopy revealed vocal fold immobility (50 of 67 cases on the left side, 74.6%) and incomplete glottal closure with anterior arytenoid dislocations in 63 cases and posterior dislocations in 4 cases. The laryngeal electromyography (LEMG) results for 10 of 38 patients (26.3%) of postintubation arytenoids dislocation displayed abnormal patterns with denervated potentials. The voice of all patients for postintubation arytenoids dislocation improved after modified closed reduction with normal in 51 cases and slight hoarseness in 6 cases. The movement of the affected vocal folds recovered to normal in 54 cases and improved in 3 cases. Among the 10 patients with nonintubated vocal fold immobility, the voice and the movement of vocal folds were normal in 7 cases, improved in 1 case and no effective in 2 cases.
Conclusions:
Some cases of arytenoid dislocation were accompanied by an recurrent laryngeal nerve abnormality (mostly temporary and resolved after a reduction). The modified reduction technique under local anesthesia can restore patients' voice and vocal fold mobility within 6 weeks after dislocation. Nevertheless, the causes of vocal fold immobility following blunt laryngeal trauma were complicated, so the curative effect of arytenoids reduction in those cases may be limited by cicatricial contracture of laryngeal injured tissue.
