Management Of Arytenoid Dislocation: A Systematic Review

The diagnosis and treatment of arytenoid dislocation (AD) and subluxation (AS) are challenging. This systematic review aims to provide an evidence-based approach to the diagnosis and management of AD/AS using only cases with confirmed intraoperative findings.

A systematic literature review was performed using the key terms arytenoid, dislocation, subluxation, and cricoarytenoid joint. The inclusion criteria were human studies in adults where the diagnosis was confirmed by intraoperative findings. Data extracted included etiology, clinical presentation, imaging and electromyography findings, treatment modality, timing of intervention, and voice outcome. Descriptive synthesis and regression analysis were performed.

Twenty-two studies comprising 104 reported cases were identified and 77 met the inclusion criteria. The most common etiologies were intubation and external laryngeal trauma. The presenting symptoms were hoarseness, breathiness, and odynophagia. AD/AS was more commonly left-sided with posterolateral displacement. Computed tomography (CT) demonstrated a sensitivity of 71% for detecting AD/AS, while laryngeal electromyography (LEMG) demonstrated a sensitivity of 54%. When CT and LEMG results were combined, the sensitivity was 59%. Closed reduction was the most common primary treatment and resulted in a normal voice outcome in 67.6% of cases. There was a significant correlation between early intervention and improved voice outcome (P-value = 0.048).

Imaging may aid in the diagnosis of AD/AS, but intraoperative confirmation of arytenoid position with palpation remains the current gold standard. Closed reduction carries a high success rate and early intervention is associated with improved voice outcome.

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