Characteristics of vocal fold immobility following endotracheal intubation.

OBJECTIVES: We investigated the clinical and laryngeal electromyography (LEMG) characteristics and the outcome of closed reduction of arytenoid cartilage dislocation in patients with vocal fold immobility (VFI) following endotracheal intubation.

METHODS: Sixty patients with VFI following endotracheal intubation were included. Closed reduction was performed under local anesthesia in 54 cases. Another 6 patients did not undergo an intervention. Laryngeal behaviors and voice function were evaluated. Forty-five patients underwent LEMG testing.

RESULTS: All patients complained of persistent hoarseness immediately following surgery. The LEMG results for 29 of 45 patients showed normal patterns (15 cases) or mildly abnormal patterns (14 cases) on the affected side. Sixteen cases displayed apparent abnormal LEMG patterns on the affected side. The voices of all 54 patients improved after reduction. The movement of the affected vocal folds recovered to normal in 51 cases. One month after reduction, neuromuscular function had improved in 29 of 30 cases.Among the 6 patients who did not undergo intervention, 3 had normal or slightly hoarse voices, and 3 experienced moderate hoarseness.

CONCLUSIONS: Vocal fold immobility following endotracheal intubation is typically caused by arytenoid dislocation. Some instances were accompanied by an abnormality of the recurrent laryngeal nerve. A timely closed arytenoid reduction should be performed to restore patients' normal voices and vocal fold mobility. Our reduction technique under local anesthesia can be performed easily and obtains satisfactory outcomes within 6 weeks after endotracheal intubation.