Incidence and Risk Factors of Arytenoid Dislocation Following Endotracheal Intubation: A Systematic Review and...

Area of Science:

• Anesthesiology and Critical Care Medicine
• Otolaryngology
• Medical Device Technology

Background:

• Endotracheal intubation is a common procedure with potential complications.
• Arytenoid dislocation (AD) is a rare but severe adverse event associated with intubation.
• Existing studies on AD incidence and risk factors have small sample sizes, leading to variable results.

Purpose of the Study:

• To determine the overall incidence of arytenoid dislocation (AD) following endotracheal intubation.
• To identify and analyze predisposing risk factors associated with AD.
• To synthesize current evidence on AD occurrence and contributing factors.

Main Methods:

• A systematic review and meta-analysis of studies published up to April 2024.
• Literature search conducted across PubMed, Scopus, Web of Science, and Cochrane Library.
• Meta-analysis of AD incidence using a random-effects model; manual synthesis for other outcomes.

Main Results:

• The pooled incidence of AD was 0.093% (CI: 0.045% to 0.14%), with high heterogeneity (I² = 91%).
• Risk factors for AD included younger age, female sex, taller stature, higher BMI, specific surgeries, esophageal instrumentation, prolonged procedures, head-neck movement, and inexperienced intubators.
• Intubation with a stylet was associated with a reduced risk of AD.

Conclusions:

• Arytenoid dislocation is a rare complication of endotracheal intubation, potentially underdiagnosed.
• Multiple patient and procedural factors contribute to AD risk, though evidence is limited by study size and heterogeneity.
• Further research is necessary to comprehensively understand and mitigate AD risk factors.