Xing Lingxi, Ding Yuyan, Zhou Yihu, Yu Lixiang, Gao Rong, Gu Lianbing
Department of Anesthesiology, The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, 210009 Nanjing, China.
Department of Otorhinolaryngology Head and Neck, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, 210019 Nanjing, China.
Int J Surg Case Rep. 2024 Nov;124:110372. doi: 10.1016/j.ijscr.2024.110372. Epub 2024 Sep 30.
Arytenoid dislocation, typically manifested as hoarseness and coughing when drinking, is a rare perioperative scenario, with an incidence rate of 0.009 %-0.097 % and endotracheal intubation under general anesthesia being the most common cause. However, arytenoid dislocation caused by a laryngeal mask airway (LMA) is extremely rare.
Herein, a 53-year-old female patient was admitted for a "right breast lump" and scheduled for "unilateral mastectomy with ipsilateral axillary sentinel lymph node biopsy" under general anesthesia. During the surgery, the patient was noted to snore mildly, and rocuronium (15 mg) was immediately administered intravenously. The snoring ceased after adjusting the position of the LMA. Postoperatively, the patient was diagnosed with arytenoid dislocation by flexible nasal endoscopy after presenting with a sore throat accompanied by hoarseness and coughing when drinking. Thereafter, the patient underwent two cricoarytenoid joint reductions with a video laryngoscope under intravenous anesthesia, along with anti-inflammatory medication and voice therapy. The voice of the patient returned to normal after 1 month.
Despite being a supraglottic airway device, the LMA can still cause arytenoid dislocation in clinical practice. Hence, anesthesiologists should analyze the potential causes and understand the diagnosis and treatment of arytenoid dislocation. Although closed reduction surgery typically requires two or three attempts, with a shorter disease duration leading to better outcomes, it can also aid in voice recovery for a longer disease course. In the presented case, the patient achieved a good prognosis after two closed reduction surgeries.
Anesthesiologists should be vigilant for arytenoid dislocation in patients who present with persistent hoarseness and coughing while drinking after the insertion of the LMA, necessitating prompt treatment after diagnoses to achieve the best results.
杓状软骨脱位是一种罕见的围手术期情况，通常表现为声音嘶哑和饮水时咳嗽，发病率为0.009% - 0.097%，全身麻醉下气管插管是最常见的原因。然而，喉罩气道（LMA）导致的杓状软骨脱位极为罕见。
在此，一名53岁女性患者因“右乳肿块”入院，计划在全身麻醉下行“单侧乳房切除术及同侧腋窝前哨淋巴结活检”。手术过程中，注意到患者有轻度打鼾，立即静脉注射罗库溴铵（15mg）。调整LMA位置后打鼾停止。术后，患者出现咽痛并伴有声音嘶哑和饮水时咳嗽，经软性鼻内镜检查诊断为杓状软骨脱位。此后，患者在静脉麻醉下用视频喉镜进行了两次环杓关节复位，同时给予抗炎药物和嗓音治疗。1个月后患者声音恢复正常。
尽管LMA是一种声门上气道装置，但在临床实践中仍可导致杓状软骨脱位。因此，麻醉医生应分析潜在原因，了解杓状软骨脱位的诊断和治疗方法。虽然闭合复位手术通常需要尝试两到三次，病程较短者预后较好，但对于病程较长者也有助于声音恢复。在本病例中，患者经过两次闭合复位手术后预后良好。
麻醉医生应对LMA置入后出现持续声音嘶哑和饮水时咳嗽的患者警惕杓状软骨脱位，确诊后需及时治疗以取得最佳效果。
