Yan Weng-Qing, Li Chen, Chen Zhi
Medical Department of Graduate School, Nanchang University, Nanchang 330006, Jiangxi Province, China.
Department of Traumatology, Jiangxi Provincial People's Hospital, Nanchang 330006, Jiangxi Province, China.
World J Clin Cases. 2022 May 26;10(15):5119-5123. doi: 10.12998/wjcc.v10.i15.5119.
Arytenoid cartilage dislocation is a rare and often overlooked complication of tracheal intubation or blunt laryngeal trauma. The most common symptom is persistent hoarseness. Although cases of arytenoid dislocation due to tracheal intubation are reported more frequently in otolaryngology, reports on its occurrence in the intensive care unit (ICU) are lacking. We report a case of delayed diagnosis of arytenoid cartilage dislocation after tracheal intubation in the ICU.
A 20-year-old woman was referred to the ICU following a fall from a height. Her voice was normal; laryngeal computed tomography showed unremarkable findings on admission. However, due to deterioration of the patient's condition, tracheal intubation, and emergency exploratory laparotomy followed by laparoscopic surgery two d later under general anesthesia were performed. After extubation, the patient was sedated and could not communicate effectively. On the 10 day after extubation, the patient complained of hoarseness and coughing with liquids, which was attributed to laryngeal edema and is common after tracheal intubation. Therefore, specific treatment was not administered. However, the patient's symptoms did not improve. Five d later, an electronic laryngoscope examination revealed dislocation of the left arytenoid cartilage. The patient underwent arytenoid closed reduction under general anesthesia by an experienced otolaryngologist. Reported symptoms improved subsequently. The six-month follow up revealed that the hoarseness had resolved within four weeks of the reduction procedure.
Symptoms of arytenoid cartilage dislocation are difficult to identify in the ICU leading to missed or delayed diagnosis among patients.
杓状软骨脱位是气管插管或钝性喉外伤罕见且常被忽视的并发症。最常见的症状是持续性声音嘶哑。虽然气管插管导致杓状软骨脱位的病例在耳鼻喉科报道较多，但在重症监护病房（ICU）发生的相关报道较少。我们报告1例ICU气管插管后杓状软骨脱位延迟诊断的病例。
一名20岁女性因高处坠落被送至ICU。入院时她声音正常，喉部计算机断层扫描未见明显异常。然而，由于患者病情恶化，进行了气管插管，并于2天后在全身麻醉下行急诊剖腹探查术及随后的腹腔镜手术。拔管后，患者处于镇静状态，无法有效沟通。拔管后第10天，患者主诉声音嘶哑及饮水时咳嗽，这归因于喉水肿，是气管插管后常见的情况。因此，未给予特殊治疗。然而，患者症状未改善。5天后，电子喉镜检查显示左侧杓状软骨脱位。患者在全身麻醉下由经验丰富的耳鼻喉科医生进行了杓状软骨闭合复位术。随后报告的症状有所改善。6个月随访显示，复位术后4周内声音嘶哑消失。
ICU中杓状软骨脱位的症状难以识别，导致患者漏诊或诊断延迟。
