Arytenoid Cartilage Dislocation from External Blunt Laryngeal Trauma: Evaluation and Therapy without Laryngeal Electromyography
Yaoshu Teng, Hui-e Wang, Zhihong Lin
Department of Otorhinolaryngology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China (mainland)
Med Sci Monit 2014; 20:1496-1502
Intubation trauma is the most common cause of arytenoid dislocation. The aim of this study was to investigate the diagnosis and treatment of arytenoid cartilage dislocation from external blunt laryngeal trauma in the absence of laryngeal electromyography (LEMG) and to explore the role of early attempted closed reduction in arytenoids cartilage reposition.
Material and Methods: This 15-year retrospective study recruited 12 patients with suspected arytenoid dislocation from external blunt laryngeal trauma, who were evaluated through 7 approaches: detailed personal history, voice handicap index (VHI) test, indirect laryngoscope, flexible fiberoptic laryngoscope, video strobolaryngoscope, and/or high-resolution computed tomography (CT), and, most importantly, the outcomes after attempted closed reduction under local anesthesia. They were divided into satisfied group (n=9) and dissatisfied group (n=3) based on their satisfied with voice qualities at 1 week after the last closed reduction manipulation.
Results: Each patient was diagnosed with arytenoid dislocation caused by external blunt laryngeal trauma. In the satisfied group, VHI scores and maximum phonation time (MPT) at 1 week after the last reduction were significantly improved compared with those before the procedure (P<0.05). Normal or improved mobility and length of the affected vocal fold were also noted immediately after the end of the last closed reduction. The median time interval between injury and clinical intervention in satisfied group was 43.44±34.13 days, much shorter than the median time of 157.67±76.07 days in the dissatisfied group (P<0.05).
Conclusions: Multimodality assessment protocols are essential for suspected arytenoid dislocation after external blunt laryngeal trauma. Early attempted closed reduction should be widely recommended, especially in health facilities without LEMG, mainly, because it could be helpful for early diagnosis and treatment of this disease. In addition, early closed reduction could also improve the success of arytenoid reduction.
Keywords: Dislocations - therapy, Arytenoid Cartilage - radiography, Adult, Electromyography, Larynx - radiography, Phonation, Time Factors, Tomography, X-Ray Computed, Vocal Cords, Wounds, Nonpenetrating - therapy, young adult