Clinical analysis of arytenoid cartilage reposition with snake mouth forceps for the arytenoid cartilage dislocation / 临床耳鼻咽喉头颈外科杂志

OBJECTIVES@#To investigate the clinical effect of the arytenoid cartilage reposition using snake mouth reduction forceps under general anesthesia.@*METHODS@#Data of twenty-six cases accepted arytenoid cartilage reposition under intravenous general anesthesia were analyzed, nineteen cases accepted laryngeal CT scan and cricoarytenoid joint reconstruction, all patients underwent endolaryngeal muscle electromyography examination. According to the position of cartilage dislocation prompted by laryngoscope and CT, the arytenoid cartilage was repositoned under the visual laryngoscope using special snake mouth reduction forceps. If bilateral arytenoid cartilage were still asymmetrically at the end of the surgery, patients needed repeated reposition 1 to 2 times 1 week after operation. The efficacy was evaluated 4 weeks later.@*RESULTS@#All patients had a hoarse and breathing voice preoperative. Under laryngoscope, there were different degrees of vocal cord movement disorders accompanied by incomplete glottis closure, 22 cases happened in left side and 4 in right side. The arytenoid cartilage was dislocated anteromedially in 25 cases and posterolaterally in 1 case. CT showed that 15 cases of arytenoid cartilage were tilted anteromedially; the interval of the cricoarytenoid joint was widened. In axial CT images, there were no direct signs of the arytenoid cartilage dislocation in the 4 cases, but the abnormal position was seen in the reconstruction images. The laryngeal electromyography indicated that 7 cases were abnormal, duration of motor unit potential were visible and the raising potential were mixed. There were 4 patients with normal voice in the first day after surgery, and 19 cases underwent twice and 3 cases underwent three times surgery. Vioce became normal in 4 weeks. Swallowing pain and bucking were all disappeared. Vocal cords movement were recovered to normal level in 25 cases. In 1 case with neck strangulation, the vocal cord movement was slightly worse than health side, but significantly better than that before operation.@*CONCLUSIONS@#The arytenoid cartilage reposition using snake mouth reduction forceps under general anesthesia was an effective method for the treatment of the cricoary-tenoid joint dislocation.

Arytenoid dislocation after uneventful endotracheal intubation: a case report / 대한마취과학회지

Arytenoid dislocation is an unusual complication of endotracheal intubation. We reported a case of a 48-year-old female with arytenoid dislocation after uneventful endotracheal intubation, which was successfully treated with arytenoid reduction. The patient complained of persistent hoarseness until the fourth day after an uneventful gynecologic surgery under general anesthesia. On laryngoscopic examination, paralyzed left vocal cord with minimal arytenoid movement was observed. An anteromedial dislocation of the left arytenoid cartilage was suspected and surgical reduction was performed by the laryngologist. The hoarseness was immediately resolved after surgical intervention. Anesthesiologists should be careful not to cause laryngeal trauma in anesthetized patients. In addition, early diagnosis and prompt surgical reduction are essential for a better prognosis for arytenoid dislocation.

Arytenoid cartilage dislocation after reversed total shoulder replacement surgery in the beach chair position: a case report / 대한마취과학회지

Arytenoid cartilage dislocation is not a common complication, but its delayed diagnosis reduces the therapeutic effect of treatment. A male patient underwent reversed total shoulder replacement surgery in the beach chair position under general anesthesia. The patient experienced postoperative hoarseness, and it was revealed that he had right arytenoid dislocation. Voice restoration was accomplished with closed reduction. We discussed changes in patient position during the operation and how they may contribute to the arytenoid dislocation. Flexion and a slight rotation of the neck during the operation can lead to an increase in intracuff pressure of the endotracheal tube. It is necessary to check neck position and monitor intracuff pressure in patients undergoing operations in the beach chair position. Also, the anesthesiologist should suspect arytenoid dislocation in the case of persistent hoarseness after surgery in the beach chair position.

A Case of Bilateral Vocal Cord Paralysis in a Patient with Rheumatoid Arthritis / 대한이비인후과학회지

Rheumatoid arthritis (RA) is a chronic inflammatory disease affecting the synovial membrane and causing joint damage and bone destruction. The symptoms of cricoarytenoid joint (CJ) arthritis often include hoarseness, and a sense of pharyngeal fullness in the throat. Sometimes, in cases with bilateral CJ involvement, an urgent tracheostomy might be required for acute airway obstruction. In this report, we describe a 45-years-old man suffering from voice change and aspiration due to hampered adduction of the vocal fold that was caused by RA with bilateral CJ involvement. The medication treatment for RA was carried out and the patient retrieved her normal voice after one month.

Transoral CO2 Laser Resection for Post-Radiation Arytenoid Edema

Arytenoid edema following radiation therapy of laryngeal cancer may persist and make careful inspection and evaluation of the larynx difficult. Moreover, it may have serious impacts on functions such as breathing, swallowing, speech and voice. Conservative management such as antibiotics and steroid may be attempted but may be ineffective in progressive and severe cases of edema. We present four cases of persistent postradiation arytenoid edema successfully treated with partial resection of the arytenoid mucosa using transoral CO2 laser.

Resection range of dog hemi-vertical larynx by semiconductor laser / 第二军医大学学报

Objective: To observe the resection range of dog hemi-vertical larynx by semiconductor laser. Methods: Twelve dogs were randomly divided into three groups (A, B and C, n = 4). Group A: the hemi-vertical larynx was cauterized forward from the anterior commissure to thyroid cartilage internal membrane, outwards including the right vocal cords. Group B: the hemi-vertical larynx was cauterized forward from anterior commissure to thyroid cartilage internal membrane and partial cartilage of anterior commissure, outwards including the right ventricular fold, vocal cord, thyroarytenoid muscle and partial lateral cricoarytenoid muscle, downwards including the lower edge of thyroid cartilage, and backwards including the partial arytenoid cartilage. Group C: the hemi-vertical larynx was cauterized forward including the anterior commissure and partial thyroid cartilage of anterior commissure, outwards including the right ventricular fold, vocal cord, thyroarytenoid muscle, lateral cricoarytenoid muscle and paraglottic space to thyroid cartilage, downwards including the partial cricothyroid membrane to the upside of cricoid cartilage, and backwards including total right arytenoid cartilage. The recovery of the laryngeal wounds, hoarseness, and complications were observed and evaluated by using digital camera and electrolaryngoscope immediately, 1 week and 4 weeks after operation. The treatment outcome of the resection was evaluated. Results: The laser surgery was completed successfully in all the animals. Laryngoscope showed that the neonatal membrane covered the wound in group A and B one week later, without obvious complications. The neonatal membrane covered part of the wound in group C, accompanied by inflammatory reaction and cough when eating. Four weeks later the new membrane over the wound surface were smooth in all the three groups; adhesion appeared in the anterior commissure and new anterior commissure was formed. A new vocal cord was formed in group A; only a small gap was seen when the glottis was closed. In Group B, the new vocal cord was narrower and thinner; granulation growth was seen in local areas; and the glottis was closed incompletely. In Group C, mucosa was slightly raised over the original location of the vocal cord. Closure of the glottis was poor. Group A had no hoarseness, Group B had moderate, and Group C had severe hoarseness, but without cough when eating. Also in Group C the lamina of thyroid cartilage of the operative side was thinner than that of the contralateral side. Conclusion: When cauterizing dog partial hemi-vertical larynx using semiconductor laser, we can resect all the soft-tissue internal the thyroid cartilage, including the arytenoid and partial thyroid cartilage in the anterior commissure. The repair is satisfactory after operation, without obvious complications.

A primary study of arytenoid within-shift combining with recurrent laryngeal nerve transposition / 中国耳鼻咽喉头颈外科

OBJECTIVE To study the therapeutic effect of arytenoid within-shift combining with recurrentlaryngeal nerve (RLN) anastomosis to ansa cervicalis for patients with long-term unilateral vocal cord paralysis (UVCP) . METHODS Twelve patients with traumatic RLNs paralysis were studied. The courses of injury varied from 3 to 22 years. RLN was anastomosed to ansa cervicalis and arytenoid was within-shifted on ipsilateral side in all patients. Therapeutic efficacy was evaluated by laryngoscope, strobe-laryngoscope, voice evaluation, voice acoustics parameter analysis, and laryngeal electromyography (LEMG) . RESULTS The voice was improved in all cases after arytenoid within-shift immediately. The mean values of voice acoustics parameters (jitter, shimmer, NNE) were significantly smaller and maximum phonation time (MPT) were significantly longer after operation compared with those of before treatment. Laryngoscope showed that arytenoid was significantly within-shifted. The glottic posterior chink vanished in 9 cases and reduced in 3 cases. The voice resumed normal, obviously improved, improved and no improved were found in 9、 3、0、0 cases respectively 12 months after operation. The mass and tension of all treated vocal cords may become the same as the contralateral normal vocal cords, thus resuming symmetric vibration of the vocal cords. The reinnervation of the RLNs were approved by LEMG in these patients whose RLNs were restored. CONCLUSION Arytenoid within-shift combining with RLN anastomosis to ansa cervical can restored normal voice in patients with long-term UVCP.

The Study for Various Movements of the Arytenoid Cartilage in Functional Diseases of Vocal Folds / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Functional diseases of vocal folds have shown various movements of the arytenoid cartilage, however, they have not been documented yet. We studied to find out the relationships between functional diseases of vocal folds and arytenoid movements. MATERIALS AND METHOD: 224 subjects were evaluated by using videostroboscopic examinations. The subjects were classified into three types; notch, ball, and flat types according to the patterns of arytenoid movement during phonation. Vocal fold lesions were investigated and arytenoid movements were compared between normal and disease groups. RESULTS: The arytenoid movements of notch type were more than ball type or flat type in both normal and disease groups. The disease group showed many asymmetric movements of arytenoid cartilage when compared with the normal group. Vocal nodule and vocal polyp showed asymmetric movements of arytenoid cartilage. Conclusions: We found that the functional diseases of vocal folds were related to the asymmetric movements of arytenoid cartilage. We suggest that the various movements of arytenoid cartilage should be considered when functional diseases of vocal folds are examined.