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Unilateral degloving injuries of the arytenoid cartilage.

Arytenoid cartilage dislocations and avulsions are often seen as a part of severe laryngeal injuries due to blunt trauma. An uncommon type of injury is the unilateral degloving of an arytenoid cartilage following laterally directed trauma to the thyroid cartilage. It may occur without additional cartilaginous or mucosal damage. The arytenoid cartilage is squeezed between the thyroid ala and the cervical spine and stripped of its mucosal covering. It may retain mobility and be exposed only on adduction, or it may lose mobility due to dislocation and be tipped into the laryngeal lumen. Prognosis for vocal cord mobility and voice production is good for the degloving injury alone, but poor if the arytenoid cartilage is also dislocated. Cases are discussed to illustrate the mechanism, treatment, and outcome of such injuries.

Adolescent↗

[Spontaneous dislocation of the arytenoid cartilage].

Dislocation of the arytenoid cartilage occurs following medical instrumentation involving the laryngeal cavity or laryngeal injury from outside the larynx. We reported a case of spontaneously posterior dislocation of the arytenoid cartilage. A 53 year-old man suffering from suddenly recurring aphonia and its improvement many over 3 months without laryngeal injury or inducement eventually ceased to improve. Laryngoscopic findings showed that the left vocal fold was tensely prolonged and the vocal process of the arytenoid cartilage on the left side was dislocated posterolaterally. X-ray videofluorography of the larynx on repetitive phonation of /he/ showed abnormally high and diagonal displacement of the vocal fold and the upper structure of the arytenoid cartilage on the left side. Palpating the cricoarytenoid joint on the left side showed abnormal swelling with tenderness. Electomyography of the intrinsic laryngeal muscle on the left side showed normal action potential. From these findings, we diagnosed his voice disorder as spontaneously posterior dislocation of the arytenoid cartilage. We manually reduced it by pulling up a balloon inserted from the piriform sinus of the affected side to the esophagus.

Arytenoid Cartilage↗

Chronic chondritis of the equine arytenoid cartilage.

Chronic chondritis of the arytenoid cartilage was diagnosed in 7 male Thoroughbred horses examined for obstructive upper airway disorders. The history of the cases was characterized by a 3- to 6-month progression of exercise intolerance and inspiratory dyspnea during exercise. Endoscopy revealed marked asymmetry of the rima glottidis, partial or complete inability to abduct the involved cartilage, and axial displacement of the involved arytenoid cartilage. In less severe cases, the disorder was confused with laryngeal hemiplegia. Focal elevated lesions of the involved cartilage, which were frequently seen, produced contact lesions on the contralateral cartilage. Subtotal arytenoidectomy was performed in 6 cases. Histologic examination of the removed cartilages revealed marked lamination of the cartilage with fibrous connective tissue. Granulating sinus tracts were seen in 3 cases. The surgical intervention resulted in marked improvement of exercise intolerance in 5 cases.

Animals↗

Arytenoid cartilage dislocation: a 20-year experience.

SUMMARY: Arytenoid cartilage dislocation is an infrequently diagnosed cause of vocal fold immobility. Seventy-four cases have been reported in the literature to date. Intubation is the most common origin, followed by external laryngeal trauma. Decreased volume and breathiness are the most common presenting symptoms. We report on 63 patients with arytenoid cartilage dislocation treated by the senior author (RTS) since 1983. Significantly more posterior than anterior dislocations were represented. Although reestablishing joint mobility is difficult, endoscopic reduction should be considered to align the heights of the vocal processes. This process may result in significant voice improvement even long after the dislocation. Strobovideolaryngoscopy, laryngeal electromyography, and laryngeal computed tomography (CT) imaging are helpful in the evaluation of patients with vocal fold immobility to help distinguish arytenoid cartilage dislocation from vocal fold paralysis. Familiarity with signs and symptoms of arytenoid cartilage dislocation and current treatment techniques improves the chances for optimal therapeutic results.

Adolescent↗

Arytenoid cartilage sclerosis: normal variations and clinical significance.

PURPOSE: Our purpose was to determine the variation in location, distribution, and sex predilection of arytenoid cartilage sclerosis in a population of patients without laryngeal cancer as an aid to understanding the significance of this entity when seen in patients with laryngeal cancer. METHODS: One hundred CT examinations of patients of different ages and with no history of laryngeal cancer or radiation therapy were evaluated for the presence of arytenoid cartilage sclerosis. The arytenoid cartilage was subdivided into three regions: superior process, body, and vocal process. Each region was assessed on each side separately on bone window scans. RESULTS: Arytenoid cartilage sclerosis was seen in 16% (n = 16) of the patients. Sclerosis was most common in the body (n = 12) and least common in the true vocal process (n = 2); the left side was the preferred location for all three regions. In 50% of the patients, at least two regions were affected. Eighty-one percent of sclerotic arytenoid cartilage was seen in women. CONCLUSION: Knowledge of the frequency and distribution of arytenoid cartilage sclerosis as a normal variant can aid in determining the risk of arytenoid cartilage involvement in patients with laryngeal cancer.

Adolescent↗

[The reconstruction of laryngeal function in subtotal laryngectomy with preservation of arytenoid cartilage].

OBJECTIVE: To evaluate subtotal laryngectomy with preservation of arytenoid cartilage to reconstruct laryngeal function in T3 glottic or supraglottic laryngeal cancer. METHODS: Subtotal laryngectomy with preservation of arytenoid cartilage to reconstruct laryngeal function was reviewed in 20 patients with T3 laryngeal cancer(3 cases with glottic cancer and 17 cases with supraglottic cancer). Recurrent laryngeal nerve was preserved during surgery. The mucous membranes between cricoid cartilage and pharynx were sewed up accordingly. RESULTS: All patients had restored phonation and swallowing functions. The 3- and 5-year survival rates were 94.1% and 91.8% respectively. Decannulation rate was 95.0%. CONCLUSION: Subtotal laryngectomy with preservation of arytenoid cartilage is recommended for T3 laryngeal cancer.

Aged↗

Idiopathic mucosal lesions of the arytenoid cartilages of 21 Thoroughbred yearlings: 1997-2001.

REASONS FOR PERFORMING STUDY: Mucosal ulcers and, occasionally, small granulomas on the axial surface of one or both arytenoid cartilages have been found in TB yearlings presented for post sale endoscopic examination. OBJECTIVES: To determine the incidence, endoscopic characteristics and outcome of a group of Thoroughbred yearlings affected with mucosal ulcers and granulomas of the arytenoid cartilage. HYPOTHESIS: The incidence of mucosal ulceration of the arytenoid cartilages of yearling Thoroughbreds is relatively high compared to other upper airway abnormalities; and that the majority of mucosal ulcers heal uneventfully, although a small percentage may progress to a granuloma and, less commonly, to arytenoid chondropathy. METHODS: The findings of post sale, upper airway endoscopic examinations of 3312 Thoroughbred yearlings, during a 5 year period, were reviewed, including those abnormalities listed in the conditions of sale and others not listed but considered likely to cause airway obstruction. Information obtained from the medical record of horses that had mucosal ulceration or granuloma of the arytenoid cartilage included the location and size of the lesion(s), sex of the affected horse and the presence and nature of other concurrent abnormalities of the upper portion of the respiratory tract. Additional information included treatment and results of follow-up, endoscopic examination by the authors or attending veterinarian. RESULTS: Mucosal lesions were seen in 0.63% of yearlings evaluated, which represented the most common, documented condition of the upper portion of the respiratory tract. The mucosal ulcers of 15 of 19 horses were considered to have healed without complication during follow-up examination; one of the 19 horses was lost to follow-up. Two horses affected with bilateral, arytenoid mucosal ulceration developed a granuloma at each site of ulceration. One horse developed a granuloma at a site of ulceration and, subsequently, arytenoid chondropathy. CONCLUSIONS: Arytenoid mucosal ulceration in sales yearlings was a relatively commonly encountered abnormality and a small percentage progressed to granuloma or chondropathy. POTENTIAL RELEVANCE: The mucosa of the arytenoid cartilage, particularly at the rostral margin of the vocal process, should be examined carefully during endoscopic examination of the upper portion of the respiratory tract of Thoroughbred yearlings presented for sale. Because a small percentage of mucosal ulcers may progress to granuloma or, less commonly, chondropathy, identification of mucosal ulcers of the arytenoid cartilage seen during post sale, endoscopic examination warrants notification to the purchaser and sales company. Medical therapy of affected horses should be considered and follow-up endoscopic examination performed to determine if the lesion has healed.

Animals↗

[A rare complication of endotracheal intubation: posterior luxation of the left arytenoid cartilage].

The luxation of the arytenoid cartilage is a very uncommon complication of endotracheal intubation. Symptoms usually are aphonia, dysphonia, pain or discomfort in the throat, odynophagia and laryngeal stridor. It may be due to several factors: the pressure of the convex aspect of the tube on the arytenoid, traumatic or prolonged intubations, reintubations within a short period, or some systemic diseases. We report a case of posterior luxation of the left arytenoid in a patient who had been anesthetized for the radical cure of a left inguinal hernia. The clinical features developed when he recovered from anesthesia, with aphonia and discomfort in the throat. The diagnosis was made by indirect laryngoscopy. Treatment with nonsteroidal antiinflammatory agents was instituted. Aphonia disappeared after 2 weeks and dysphonia persisted. The patient became asymptomatic with corticosteroids on the fourth week after operation. Early diagnosis under laryngoscopic vision is recommended, with adequate therapy to prevent fibrosis of the cricoarytenoid joint with permanent sequelae.

Adult↗

[Intubation trauma of the larynx--a literature review with special reference to arytenoid cartilage dislocation].

Trauma to the cricoarytenoid joint represents a rare but serious complication of endotracheal intubation. Subluxation and luxation of the arytenoid cartilage may occur during difficult but also following uncomplicated intubation. Forces on the arytenoid cartilage exerted by the laryngoscope blade or by the distal part of the endotracheal tube may cause anterior and inferior displacement of the arytenoid cartilage. Due to the conventional intubation technique the left arytenoid cartilage is affected most frequently. Posterolateral subluxation is attributed to the pressure exerted on the posterior glottis by the convex part of the shaft of the tube. Systemic diseases (e.g. terminal renal insufficiency, bowel diseases, acromegaly) may cause degeneration of the cricoarytenoid ligaments, thus making the cricoarytenoid joint more susceptible to traumatic dislocation. Persisting alterations of voice, sore throat and pain on swallowing may hint to the diagnosis of arytenoid dislocation. However, stridor and shortness of breath have also been observed. If pharyngo-laryngeal complaints persist, evaluation by laryngologists is mandatory. In addition to indirect and direct laryngoscopy, computerised tomography and electromyography of the larynx play an important role in differentiating arytenoid dislocation from true vocal cord paralysis due to nerve damage. Early operative reposition results in fair prognosis, whereas delayed diagnosis may lead to ankylosis of the cricoarytenoid joint with permanent impairment of the voice and possibly compromised airway protection.

Anesthesia, Endotracheal↗

Upper airway dysfunction associated with collapse of the apex of the corniculate process of the left arytenoid cartilage during exercise in 15 horses.

OBJECTIVE: To report dynamic collapse of the apex of the left corniculate process under the right corniculate process into the airway at the dorsal apposition of the paired arytenoid cartilages during exercise as a cause of upper airway dysfunction in horses. DESIGN: Retrospective study. ANIMALS: Fifteen horses with a history of poor performance and/or upper respiratory tract noise during exercise. METHODS: Video recordings of all horses referred for upper airway evaluation using high-speed treadmill videoendoscopy (HSTV) between January 1998 and December 2003 were reviewed. Records of horses that developed dynamic collapse of the apex of the left corniculate process into the airway were included. Clinical history, age, gender, breed, and use of the horse were retrieved. RESULTS: Of 309 horses referred for examination for poor performance and/or upper respiratory tract noise during exercise, 15 (4.9%) had collapse of the apex of the left corniculate process under the right and into the airway at the dorsal apposition between the paired arytenoid cartilages during HSTV. There were 3 females and 13 males, aged from 2 to 5 years. Five horses had previous surgery for left recurrent laryngeal neuropathy (RLN): 2 had nerve muscle pedicle graft and 3 had laryngeal prosthesis. During HSTV, all 15 horses had progressive collapse of the apex of the left corniculate process under the right at the dorsal apposition of the 2 arytenoid cartilages, and into the dorsal aspect of the rima glottidis. Review of video recordings revealed that collapse of the apex of the corniculate process was followed by progressive collapse of the left aryepiglottic fold and left vocal fold. The ventral aspect of the left corniculate cartilage maintained abduction in all horses. Two horses also had progressive collapse of the right vocal fold, 1 had rostral displacement of the palatopharyngeal arch, and another had dorsal displacement of the soft palate. CONCLUSIONS: Dynamic collapse of the apex of the left corniculate process of the arytenoid cartilage under the right is an uncommon cause of upper airway dysfunction in horses and the pathogenesis is unclear. We speculate that the left arytenoideus transversus muscle is unable to support the dorsal apposition between the arytenoid cartilages. This loss of support allows the elastic cartilage of the left corniculate process to collapse under the right and into the airway, as inspiratory pressure increases during exercise. This condition may be associated with an unusually advanced neuropathy of the adductor components of the left recurrent laryngeal nerve and may be an unusual manifestation of RLN; however, this is speculative and further investigation is required to determine its cause. CLINICAL RELEVANCE: Dynamic collapse of the apex of the left corniculate process and into the airway at the dorsal apposition between the paired arytenoid cartilages can only be diagnosed during HSTV. It is an uncommon cause of upper airway dysfunction but may affect the athletic potential of racing Thoroughbreds and Standardbreds.

Animals↗

Bilateral arytenoid cartilage lateralization for laryngeal paralysis in the dog.

Bilateral arytenoid cartilage lateralization was used successfully to treat 3 dogs with bilateral laryngeal paralysis. In our hands, this techniques was more effective than unilateral arytenoid cartilage lateralization in resolving the signs of laryngeal paralysis and in avoiding the complications that may follow partial laryngectomy.

Animals↗

In vitro comparison of two techniques for suture prosthesis placement in the muscular process of the equine arytenoid cartilage.

OBJECTIVE: To compare in vitro the load necessary for a partial and complete rupture of the muscular process arytenoid cartilage when a suture prosthesis is positioned by a bone trocar versus a trocar point needle and to compare failure mode. STUDY DESIGN: Experimental using cadaver specimens. SAMPLE POPULATION: Larynges from 18 Thoroughbred race horses, aged 2-20 years. METHODS: Arytenoid cartilages were separated randomly into 2 groups: group 1-suture prosthesis inserted directly through the muscular process using a curved trocar point needle and group 2-suture passed through a hole predrilled with a 3 mm bone trocar. Distracting force (constant rate, 1 mm/s) was applied to the suture until failure of the muscular process. Partial failure load, maximum load at complete failure, and force-time curve were recorded. Each arytenoid cartilage was examined, radiographed, and classified as having a linear or curved failure plane. RESULTS: No significant differences in mechanical test variables were detected. Failure mode followed the fissures occurring at the beginning of failure and then followed the tension axis. Significantly more linear failures occurred in group 2 (trocar) and more curved failures occurred in group 1 (needle). CONCLUSION: Use of a bone trocar for tunneling through the muscular process may reduce fissure formation. CLINICAL RELEVANCE: Use of bone trocar to create a hole in the muscular process of the arytenoid cartilage for suture passage in laryngoplasty may reduce fissure formation and decrease the risk of cartilage failure from suture pullout.

Animals↗

Laryngeal carcinoma: sclerotic appearance of the cricoid and arytenoid cartilage--CT-pathologic correlation.

PURPOSE: To assess the significance of sclerotic-appearing cricoid and arytenoid cartilage with computed tomography (CT) in patients with laryngeal carcinoma. MATERIALS AND METHODS: CT scans obtained in 75 patients with laryngeal carcinoma were prospectively studied; laryngeal CT studies obtained in 50 patients without laryngeal carcinoma were retrospectively reviewed. RESULTS: Twenty-four of the 75 patients (32%) with laryngeal carcinoma had sclerotic cartilage. Evaluation of pathologic specimens obtained in 12 of these 24 patients showed 11 cases of sclerotic arytenoid cartilage and two cases of sclerotic cricoid cartilage. Tumor infiltration was demonstrated in six of these cases but not in the seven others. In 11 of the 12 cases with pathologic proof, however, tumor was adjacent to the perichondrium. In the 12 cases without pathologic proof, the proportion was similar. The positive predictive value of this sign for cartilaginous invasion was 46%. CONCLUSION: Although it is not a reliable sign of cartilaginous invasion, sclerotic-appearing cricoid and arytenoid cartilage in patients with laryngeal carcinoma is predictive of the tumor to this cartilage.

Adult↗

[Reconstruction of laryngeal defect in vertical partial laryngectomy with resection of arytenoid cartilage].

OBJECTIVE: To discuss the method to reconstruct laryngeal defect after vertical partial laryngectomy with resection of arytenoid cartilage. METHODS: Laryngeal defect was reconstructed with local tissues after vertical partial laryngectomy with resection of arytenoid cartilage on 87 patients with laryngeal carcinoma of glottic type (T1 7 cases, T2 54 cases, T3 26 cases). All the lesions invaded arytenoid area or vocal process. No filling tissues were used to increase the height of affected arytenoid area and no skin flap or other tissues were used to reconstruct the vocal cord in all the patients. RESULTS: All the patients recovered normal swallow in 8 to 19 days postoperation and restored phonation. The decannulation rate was 98.9% (86/87). There were no pharyngeal fistula and pulmonary complications after operation. Local infection occurred in 3 patients and was cured in 7 days. The rate of local recurrence and cervical lymph node metastasis were 8.0% (7/87), 6.9% (6/87) respectively. Lost patients were assumed to death and direct method was used to calculate survival rate. In 87 patients postoperative period was above 3 years, 5 died in 3 years and 3 were lost 3- year survival rate was 90.8% (79/87). In 63 patients postoperative period was above 5 years, 10 died in 5 years and 2 were lost. 5- year survival rate was 81.0% (51/63). CONCLUSIONS: Utilizing local tissues to reconstruct laryngeal defect after vertical partial laryngectomy with resection of arytenoid cartilage will not lead to severe dysphagia. Phonation is acceptable. It not only saves the operation time but also avoids the negative effects of immoderate reparation.

Adult↗

[An observation on long-term results of subtotal laryngectomy with preservation of an arytenoid cartilage].

OBJECTIVE: To discuss the long-term results of the subtotal laryngectomy with preservation of an arytenoids cartilage. METHODS: The long-term results of the subtotal laryngectomy with preservation of an arytenoids cartilage were analysed in 82 patients with squamous cell carcinoma of larynx (stage III 73 cases, IV 9 cases; supraglottic type 71 cases, glottic 6, transglottic 5). RESULTS: The functions of speech and deglutition were recovered in 82 patients, and the respirations were normal in 69 of 82 cases (84.2%). Pharyngeal fistula appeared in 2 cases, and the infection of incision wound in 6, but all of them were cured by conservative treatment. All of 82 cases were followed-up for more than 5 years, 5 cases were lost follow-up, so the follow-up rate was 93.3%. 26 patients died of various causes during 5 years after operation. 5 of 26 cases died of local recurrence of laryngeal carcinoma, neck metastasis in 4, others in 4 (cardiac insufficiency, myocardiac infarction, lungs metastasis, rectal carcinoma 1 case, respectively) unknown in 4, lost follow-up in 5.68 patients were followed-up for more than 10 years, 30 cases were dead (26 cases who died of various causes included during 5 years after operation; died of local recurrence in larynx was 1 case, unknown 2, lost follow-up 1, during 5 approximately 10 years after surgery). 5, 10 years survival rates were 68.3% (56/82) and 55.9% (38/68), respectively. CONCLUSIONS: Subtotal laryngectomy with preservation of an arytenoids cartilage is recommended for T3 and some elective T4 laryngeal carcinoma.

Adult↗

Spontaneous reposition of a dislocated arytenoid cartilage.

We report a patient suffering from arytenoid cartilage dislocation after difficult tracheal intubation and the abrupt spontaneous reposition in the course of severe vomiting 1 month after the operation. Predisposing factors for the unusual reposition are discussed.

Arytenoid Cartilage↗