Chun Eun H, Baik Hee J, Chung Rack K, Lee Hun J, Shin Kwangseob, Woo Jae H
Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University Department of Anesthesiology and Pain Medicine, Ewha Womans University Mokdong Hospital, Seoul, Korea.
Medicine (Baltimore). 2017 Nov;96(45):e8514. doi: 10.1097/MD.0000000000008514.
Arytenoid dislocation is very rare and may be misdiagnosed as vocal cord paralysis or a self-limiting sore throat.
A 70-year-old male (70 kg, 156 cm) was scheduled for transurethral resection of bladder tumors. A McGrath videolaryngoscope, with a basic cuffed Mallinckrodt oral tracheal tube of 7.5 mm internal diameter, was used to successfully intubate his trachea. The duration of surgery was 25 minutes. In the recovery room, he complained of sore throat and dyspnea with inspiratory stridor, which were not resolved after intravenous injection of 10 mg of dexamethasone.
The otolaryngological examination revealed midline fixation of the bilateral vocal folds, suggestive of bilateral arytenoid dislocation or bilateral vocal cord palsy. The latter was ruled out because there was no evidence of recurrent laryngeal nerve injury.
Under general anesthesia, a closed reduction was performed using laryngoscopic forceps to apply posterolateral pressure on the arytenoid joints on both sides. Only the dislocation of the left cricoarytenoid joint could be easily reduced, whereas reduction of the right joint was not possible.
On postoperative day 7, examination with a rigid laryngoscope showed a medially fixed right vocal fold, with full compensation by the left vocal fold. Computed tomography of the neck showed no pathologic findings. Six weeks after surgery, the patient had regained his normal voice with no complications.
Although arytenoid dislocation is a rare complication, it should be considered even in patients with uncomplicated tracheal intubation. Early diagnosis and the optimal therapeutic approach are critical for restoration of the patient's original vocal cord function.
杓状软骨脱位非常罕见，可能会被误诊为声带麻痹或自限性咽痛。
一名70岁男性（体重70千克，身高156厘米）计划进行经尿道膀胱肿瘤切除术。使用麦格拉斯视频喉镜及内径7.5毫米的基本带套囊的马利克罗德口腔气管导管成功为其气管插管。手术时长25分钟。在恢复室，他主诉咽痛、呼吸困难伴吸气性喘鸣，静脉注射10毫克地塞米松后症状未缓解。
耳鼻喉科检查显示双侧声带中线固定，提示双侧杓状软骨脱位或双侧声带麻痹。由于没有喉返神经损伤的证据，排除了后者。
在全身麻醉下，使用喉镜钳进行闭合复位，对双侧杓状软骨关节施加后外侧压力。仅左侧环杓关节脱位能够轻易复位，而右侧关节无法复位。
术后第7天，硬质喉镜检查显示右侧声带内侧固定，左侧声带完全代偿。颈部计算机断层扫描未发现病理改变。术后六周，患者声音恢复正常，无并发症。
尽管杓状软骨脱位是一种罕见的并发症，但即使在气管插管无并发症的患者中也应予以考虑。早期诊断和最佳治疗方法对于恢复患者原来的声带功能至关重要。
