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Jiang T, Fang B, Yu Z, Cao D. Hoarseness and arytenoid dislocation: A rare complication after facial bony contouring surgery. J Plast Reconstr Aesthet Surg 2023; 84:432-438. [PMID: 37413735 DOI: 10.1016/j.bjps.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/28/2023] [Accepted: 06/05/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Arytenoid dislocation is a rare complication after endotracheal intubation and may result in permanent hoarseness, which cannot be tolerated during cosmetic surgeries, such as facial bony contouring surgery. This study aimed to identify the clinical characteristics of this patient subgroup and share the process of diagnosis and treatment. METHODS We retrospectively collected the medical records of patients who underwent facial bony contouring surgery under general anesthesia with endotracheal intubation from September 2017 to July 2022. We divided the patients into a nondislocation group and a dislocation group. Demographic, anesthetic, and surgical characteristics were collected and compared. RESULTS 441 patients were enrolled, and 5 (1.1%) were diagnosed with arytenoid dislocation. The patients in the dislocation group were more likely to be intubated with the video laryngoscope (P = 0.049), and head-neck movement during surgery may predispose patients to arytenoid dislocation (P = 0.019). The patients in the dislocation group were diagnosed around 5-37 days after surgery. Three of them regained their normal voice after close reduction, and two recovered with speech therapy. CONCLUSION Arytenoid dislocation may result from multiple factors instead of one high-risk factor. Head-neck movement, the skills and experience of anesthetists, the time of intubation, and the use of intubation tools may all predispose patients to arytenoid dislocation. To acquire timely diagnosis and treatment, patients should be fully informed of this complication before surgery and observed closely afterward. Any postoperative voice or laryngeal symptoms lasting more than 7 days need a specialist evaluation.
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Affiliation(s)
- Taoran Jiang
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Zhizaoju Road 639, Shanghai 200011, PR China
| | - Bin Fang
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Zhizaoju Road 639, Shanghai 200011, PR China
| | - Zheyuan Yu
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Zhizaoju Road 639, Shanghai 200011, PR China.
| | - Dejun Cao
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Zhizaoju Road 639, Shanghai 200011, PR China.
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Jang EA, Yoo KY, Lee S, Song SW, Jung E, Kim J, Bae HB. Head-neck movement may predispose to the development of arytenoid dislocation in the intubated patient: a 5-year retrospective single-center study. BMC Anesthesiol 2021; 21:198. [PMID: 34330223 PMCID: PMC8325301 DOI: 10.1186/s12871-021-01419-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/30/2021] [Indexed: 11/17/2022] Open
Abstract
Background Arytenoid dislocation is a rare laryngeal injury that may follow endotracheal intubation. We aimed to determine the incidence and risk factors for arytenoid dislocation after surgery under general anaesthesia. Methods We reviewed the medical records of patients who underwent operation under general anaesthesia with endotracheal intubation from January 2014 to December 2018. Patients were divided into the non-dislocation and dislocation groups depending on the presence or absence of arytenoid dislocation. Patient, anaesthetic, and surgical factors associated with arytenoid dislocation were determined using Poisson regression analysis. Results Among the 25,538 patients enrolled, 33 (0.13%) had arytenoid dislocation, with higher incidence after anterior neck and brain surgery. Patients in the dislocation group were younger (52.6 ± 14.4 vs 58.2 ± 14.2 yrs, P = 0.025), more likely to be female (78.8 vs 56.5%, P = 0.014), and more likely to be intubated by a first-year anaesthesia resident (33.3 vs 18.5%, P = 0.048) compared to those in the non-dislocation group. Patient positions during surgery were significantly different between the groups (P = 0.000). Multivariable Poisson regression identified head-neck positioning (incidence rate ratio [IRR], 3.10; 95% confidence interval [CI], 1.50–6.25, P = 0.002), endotracheal intubation by a first-year anaesthesia resident (IRR, 2.30; 95% CI, 1.07–4.64, P = 0.024), and female (IRR, 3.05; 95% CI, 1.38–7.73, P = 0.010) as risk factors for arytenoid dislocation. Conclusion This study showed that the incidence of arytenoid dislocation was 0.13%, and that head-neck positioning during surgery, less anaesthetist experience, and female were significantly associated with arytenoid dislocation in patients who underwent surgeries under general anaesthesia with endotracheal intubation.
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Affiliation(s)
- Eun-A Jang
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Chonnam National University Hospital, 160, Baekseo-ro, Dong-gu, Gwangju, 501 746, Korea
| | - Kyung Yeon Yoo
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Chonnam National University Hospital, 160, Baekseo-ro, Dong-gu, Gwangju, 501 746, Korea
| | - Seongheon Lee
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Chonnam National University Hospital, 160, Baekseo-ro, Dong-gu, Gwangju, 501 746, Korea
| | - Seung Won Song
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Chonnam National University Hospital, 160, Baekseo-ro, Dong-gu, Gwangju, 501 746, Korea
| | - Eugene Jung
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Chonnam National University Hospital, 160, Baekseo-ro, Dong-gu, Gwangju, 501 746, Korea
| | - Joungmin Kim
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Chonnam National University Hospital, 160, Baekseo-ro, Dong-gu, Gwangju, 501 746, Korea.
| | - Hong-Beom Bae
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Chonnam National University Hospital, 160, Baekseo-ro, Dong-gu, Gwangju, 501 746, Korea.
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Frosolini A, Marioni G, Maiolino L, de Filippis C, Lovato A. Current management of arytenoid sub-luxation and dislocation. Eur Arch Otorhinolaryngol 2020; 277:2977-2986. [PMID: 32447498 DOI: 10.1007/s00405-020-06042-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 05/08/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To review the current management of arytenoid subluxation/dislocation (AS/AD) focusing on diagnostic, therapeutic, and prognostic controversies. METHODS The international literature of the last 20 years has been considered. After the application of inclusion criteria, 20 studies were selected (471 AS/AD cases in total). RESULTS All the included investigations were retrospective case series. AS/AD was often iatrogenic occurring at least in 0.01% of patients undergone endo-tracheal intubation. The most common symptom was persistent hoarseness. The diagnosis was made by video-laryngoscopy and neck computed tomography in most reports, while some used also laryngeal electromyography. Laryngeal electromyography was fundamental to rule out unilateral vocal fold paralysis, the main differential diagnosis. The surgical relocation of AS/AD under general or local anesthesia was achieved in about 80% of patients. CONCLUSION AS/AD is a mechanical disorder of the larynx that can be successfully treated if promptly diagnosed. Clinical trials and multi-centric studies are necessary to set management guidelines.
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Affiliation(s)
- Andrea Frosolini
- Audiology Unit at Treviso Hospital, Department of Neuroscience DNS, University of Padova, Piazzale Ospedale 1, 31100, Treviso, Italy
| | - Gino Marioni
- Otolaryngology Unit, Department of Neuroscience DNS, University of Padova, Padova, Italy
| | - Luigi Maiolino
- ENT Section, Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, Catania, Italy
| | - Cosimo de Filippis
- Audiology Unit at Treviso Hospital, Department of Neuroscience DNS, University of Padova, Piazzale Ospedale 1, 31100, Treviso, Italy
| | - Andrea Lovato
- Audiology Unit at Treviso Hospital, Department of Neuroscience DNS, University of Padova, Piazzale Ospedale 1, 31100, Treviso, Italy.
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Hunter EJ, Cantor-Cutiva LC, van Leer E, van Mersbergen M, Nanjundeswaran CD, Bottalico P, Sandage MJ, Whitling S. Toward a Consensus Description of Vocal Effort, Vocal Load, Vocal Loading, and Vocal Fatigue. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:509-532. [PMID: 32078404 PMCID: PMC7210446 DOI: 10.1044/2019_jslhr-19-00057] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Purpose The purpose of this document is threefold: (a) review the uses of the terms "vocal fatigue," "vocal effort," "vocal load," and "vocal loading" (as found in the literature) in order to track the occurrence and the related evolution of research; (b) present a "linguistically modeled" definition of the same from the review of literature on the terms; and (c) propose conceptualized definitions of the concepts. Method A comprehensive literature search was conducted using PubMed/MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Scientific Electronic Library Online. Four terms ("vocal fatigue," "vocal effort," "vocal load," and "vocal loading"), as well as possible variants, were included in the search, and their usages were compiled into conceptual definitions. Finally, a focus group of eight experts in the field (current authors) worked together to make conceptual connections and proposed consensus definitions. Results The occurrence and frequency of "vocal load," "vocal loading," "vocal effort," and "vocal fatigue" in the literature are presented, and summary definitions are developed. The results indicate that these terms appear to be often interchanged with blurred distinctions. Therefore, the focus group proposes the use of two new terms, "vocal demand" and "vocal demand response," in place of the terms "vocal load" and "vocal loading." We also propose standardized definitions for all four concepts. Conclusion Through a comprehensive literature search, the terms "vocal fatigue," "vocal effort," "vocal load," and "vocal loading" were explored, new terms were proposed, and standardized definitions were presented. Future work should refine these proposed definitions as research continues to address vocal health concerns.
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Affiliation(s)
- Eric J. Hunter
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing
| | - Lady Catherine Cantor-Cutiva
- Department of Collective Health, Universidad Nacional de Colombia, Bogotá
- Department of Speech and Language Pathology, Universidad Manuela Beltrán, Bogotá, Colombia
| | - Eva van Leer
- Department of Communication Sciences and Disorders, Georgia State University, Atlanta
| | | | - Chaya Devie Nanjundeswaran
- Department of Audiology and Speech-Language Pathology, East Tennessee State University, Johnson City, TN
| | - Pasquale Bottalico
- Department of Speech and Hearing Science, University of Illinois at Urbana–Champaign
| | - Mary J. Sandage
- Department of Communication Disorders, Auburn University, AL
| | - Susanna Whitling
- Department of Logopedics, Phoniatrics and Audiology, Lund University, Sweden
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Hung KC, Chen YT, Chen JY, Kuo CY, Wu SC, Chiang MH, Lan KM, Wang LK, Sun CK. Clinical characteristics of arytenoid dislocation in patients undergoing bariatric/metabolic surgery: A STROBE-complaint retrospective study. Medicine (Baltimore) 2019; 98:e15318. [PMID: 31027101 PMCID: PMC6831391 DOI: 10.1097/md.0000000000015318] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Tracheal intubation and the use of a large-bore calibrating orogastric (OG) tube have been reported to increase the incidence of arytenoid dislocation (AD) in patients undergoing bariatric/metabolic surgery. This study aimed at identifying the clinical characteristics of this patient subgroup.We retrospectively examined the clinical characteristics of 14 patients with AD (study group) who received tracheal intubation and OG insertion for bariatric/metabolic surgery between 2011 and 2016. For comparison, another group of 19 patients with postoperative AD collected from published literature and 3 patients from the authors' institute served as controls in whom only tracheal intubation was performed. Information on patient characteristics, anesthetic time, symptoms, time of symptom onset, intervention, and postinterventional impact on vocalization of the 2 groups were collected and compared.Patients in the study group were younger than those in the control group (38 [25-60] vs 54.5 [19-88] years, P = .03). Compared with the control group, anesthetic time (282.5 [155-360] vs 225 [25-480] minutes, P = .041) was longer and symptom onset (1.0 [0-6] vs 1.0 [0-6] days, P = .018) was more delayed in the study group. After closed reduction, the frequency of voice recovery was comparable in both groups in a time interval of 12 weeks (84.6% vs 92.9%, P = .59).Our report demonstrates that the clinical characteristics of patients with AD who received tracheal intubation and OG insertion for bariatric/metabolic surgery were different from those with postoperative AD receiving only tracheal intubation, highlighting the importance of implementing individualized strategies for AD prevention in this patient population.
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Affiliation(s)
- Kuo-Chuan Hung
- Department of Anaesthesiology, Chi Mei Medical Center, Tainan
| | - Yi-Ting Chen
- Department of Anaesthesiology, Chang Gung Memorial Hospital, Chia-Yi
| | - Jen-Yin Chen
- Department of Anaesthesiology, Chi Mei Medical Center, Tainan
- Department of the Senior Citizen Service Management, Chia Nan University of Pharmacy and Science, Tainan
| | - Chuan-Yi Kuo
- Department of Anaesthesiology, E-Da Hospital, I-Shou University
| | - Shao-Chun Wu
- Department of Anaesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine
| | - Min-Hsien Chiang
- Department of Anaesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine
| | - Kuo-Mao Lan
- Department of Anaesthesiology, Chi Mei Medical Center, Tainan
| | - Li-Kai Wang
- Department of Anaesthesiology, Chi Mei Medical Center, Tainan
| | - Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Hospital, School of Medicine for International Students, I-Shou University, Kaohsiung, Taiwan
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Tsuru S, Wakimoto M, Iritakenishi T, Ogawa M, Hayashi Y. Cardiovascular operation: A significant risk factor of arytenoid cartilage dislocation/subluxation after anesthesia. Ann Card Anaesth 2018; 20:309-312. [PMID: 28701595 PMCID: PMC5535571 DOI: 10.4103/aca.aca_71_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background: Arytenoid cartilage dislocation/subluxation is one of the rare complications following tracheal intubation, and there have been no reports about risk factors leading this complication. From our clinical experience, we have an impression that patients undergoing cardiovascular operations tend to be associated with this complication. Aims: We designed a large retrospective study to reveal the incidence and risk factors predicting the occurrence and to examine whether our impression is true. Settings and Designs: This was a retrospective study. Methods: We retrospectively studied 19,437 adult patients who were intubated by an anesthesiologist in our operation theater from 2002 to 2008. The tracheal intubation was performed by a resident anesthesiologist managing the patients. Only patients whose postoperative voice was disturbed more than 7 days were referred to the Department of Otorhinolaryngology-Head and Neck Surgery and examined using laryngostroboscopy by a laryngologist to diagnose arytenoid cartilage dislocation/subluxation. We evaluated age, sex, weight, height, duration of intubation, difficult intubation, and major cardiovascular operation as risk factors to lead this complication. Statistical Analysis: The data were analyzed by logistic regression analysis to assess factors for arytenoid cartilage dislocation/subluxation after univariate analyses using logistic regression analysis. Results: Our analysis indicated that difficult intubation (odds ratio: 12.1, P = 0.018) and cardiovascular operation (odds ratio: 9.9, P < 0.001) were significant risk factors of arytenoid cartilage dislocation/subluxation. Conclusion: The present study demonstrated that major cardiovascular operation is one of the significant risk factors leading this complication.
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Affiliation(s)
- Seri Tsuru
- Department of Anesthesiology, Osaka University Hospital, Osaka, Japan
| | - Mayuko Wakimoto
- Department of Anesthesiology, Osaka University Hospital, Osaka, Japan
| | | | - Makoto Ogawa
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Hospital, Osaka, Japan
| | - Yukio Hayashi
- Department of Anesthesiology Service, Sakurabashi-Watanabe Hospital, Osaka, Japan
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Clinical Characteristics of Arytenoid Dislocation After Endotracheal Intubation. J Craniofac Surg 2016; 26:1358-60. [PMID: 26080195 DOI: 10.1097/scs.0000000000001749] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE The objective of this study was to review the clinical characteristics of the arytenoid dislocations after the endotracheal intubation and to identify the factors affecting voice recovery in the arytenoid dislocation after the endotracheal intubation. METHODS A retrospective chart review was performed at Chonnam National University Hwasun Hospital from April 2008 to February 2014. RESULTS A total of 13 patients with the arytenoid dislocation were identified. The patients had undergone the endotracheal intubation for head and neck surgery (n = 7), abdominal surgery (n = 4), and orthopedic surgery (n = 2). The most common symptom was hoarseness (100%), followed by swallowing difficulty (15.4%). All of the patients with the arytenoid dislocations after the endotracheal intubation were treated by the closed reduction. All of the patients regained normal voice and vocal fold movement after the closed reduction in spite of late surgical intervention. There was no statistical significance between the Cormack-Lehane classification, expertise of anesthetist, patient's position, operation time, duration between first operation and the closed reduction, and period of voice improvement. CONCLUSION This study indicates that the arytenoid dislocations after the endotracheal intubation may be needed for the aggressive surgical intervention, even if the diagnosis was delayed.
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Oh TK, Yun JY, Ryu CH, Park YN, Kim NW. Arytenoid dislocation after uneventful endotracheal intubation: a case report. Korean J Anesthesiol 2016; 69:93-6. [PMID: 26885311 PMCID: PMC4754277 DOI: 10.4097/kjae.2016.69.1.93] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 07/16/2015] [Accepted: 07/27/2015] [Indexed: 12/24/2022] Open
Abstract
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.
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Affiliation(s)
- Tak Kyu Oh
- Department of Anesthesiology and Pain Medicine, National Cancer Center, Goyang, Korea
| | - Jung-Yeon Yun
- Department of Anesthesiology and Pain Medicine, National Cancer Center, Goyang, Korea
| | - Chang Hwan Ryu
- Head and Neck Oncology Clinic, Center for Specific Organ Cancer and Center for Thyroid Cancer, National Cancer Center, Goyang, Korea
| | - Yu Na Park
- Department of Anesthesiology and Pain Medicine, National Cancer Center, Goyang, Korea
| | - Nam Woo Kim
- Department of Anesthesiology and Pain Medicine, National Cancer Center, Goyang, Korea
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Shen L, Wang WT, Yu XR, Zhang XH, Huang YG. Evaluation of Risk Factors for Arytenoid Dislocation after Endotracheal Intubation: a Retrospective Case-control Study. ACTA ACUST UNITED AC 2014; 29:221-4. [DOI: 10.1016/s1001-9294(14)60074-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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10
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Pediatric Arytenoid Dislocation: Diagnosis and Treatment. J Voice 2014; 28:115-22. [DOI: 10.1016/j.jvoice.2013.08.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 08/27/2013] [Indexed: 12/18/2022]
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Cooper RM, Khan S. Extubation and Reintubation of the Difficult Airway. BENUMOF AND HAGBERG'S AIRWAY MANAGEMENT 2013. [PMCID: PMC7158180 DOI: 10.1016/b978-1-4377-2764-7.00050-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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A Rare Complication of Tracheal Intubation: Tongue Perforation. Case Rep Anesthesiol 2012; 2012:281791. [PMID: 23056962 PMCID: PMC3465871 DOI: 10.1155/2012/281791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 09/06/2012] [Indexed: 11/30/2022] Open
Abstract
Aim. To describe the subsequent treatment of airway trauma sustained during laryngoscopy and endotracheal intubation.
Methods. A rare injury occurring during laryngoscopy and endotracheal intubation that resulted in perforation of the tongue by an endotracheal tube and the subsequent management of this unusual complication are discussed. A 65-year-old female with intraparenchymal brain hemorrhage with rapidly progressive neurologic deterioration had the airway secured prior to arrival at the referral institution. The endotracheal tube (ETT) was noted to have pierced through the base of the tongue and entered the trachea, and the patient underwent operative laryngoscopy to inspect the injury and the ETT was replaced by tracheostomy. Results. Laryngoscopy demonstrated the ETT to perforate the base of the tongue. The airway was secured with tracheostomy and the ETT was removed. Conclusions. A wide variety of complications resulting from direct and video-assisted laryngoscopy and tracheal intubation have been reported. Direct perforation of the tongue with an ETT and ability to ventilate and oxygenate subsequently is a rare injury.
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Norris BK, Schweinfurth JM. Arytenoid dislocation: An analysis of the contemporary literature. Laryngoscope 2011; 121:142-6. [PMID: 21181984 DOI: 10.1002/lary.21276] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES/HYPOTHESIS To discuss the incidence, diagnosis, laryngeal findings, and management of arytenoid dislocation as a separate entity from vocal fold paralysis. STUDY DESIGN Literature review. METHODS A contemporary review of the literature was performed by searching the terms arytenoid cartilage dislocation and subluxation in various combinations. Articles were analyzed and selected based on relevance and content. RESULTS Arytenoid dislocation is described as an uncommon laryngeal finding associated with intubation or blunt laryngeal trauma. The majority of recent publications are case reports or small case series. Diagnosis of arytenoid dislocation with flexible laryngoscopy, helical computed tomography, videostroboscopy, and laryngeal electromyography is recommended. In most reported cases, diagnosis has been made based on the position of the arytenoid at laryngoscopy. Reduction and repositioning of the arytenoid cartilage is reported with limited success noted with delayed diagnosis. Speech therapy may also be a beneficial treatment option. CONCLUSIONS Although arytenoid dislocation is reported in the literature, the body of available evidence fails to sufficiently differentiate it as a separate entity from unilateral vocal fold paralysis. Flexible laryngoscopy is inadequate as a standalone procedure to distinguish arytenoid dislocation from laryngeal nerve injury.
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Affiliation(s)
- Byron K Norris
- Department of Otolaryngology and Communicative Sciences, University of Mississippi, Jackson, Mississippi, USA.
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