Clinical features and surgical outcomes following closed reduction of arytenoid dislocation

Seung Won Lee, Ki Nam Park, Nathan V Welham
JAMA Otolaryngology—Head & Neck Surgery 2014, 140 (11): 1045-50

IMPORTANCE: Arytenoid dislocation is a rare condition characterized by vocal fold immobility and is easily mistaken as recurrent laryngeal nerve paralysis.

OBJECTIVE: To describe the presenting features, multimodal diagnostic evaluation, and surgical outcomes following closed reduction (CR) of arytenoid dislocation.

DESIGN, SETTING, AND PARTICIPANTS: Prospective case series at a single academic medical center. Evaluation and treatment data were obtained from 22 consecutive patients with arytenoid dislocation over a 7-year period.

INTERVENTIONS: Patients underwent direct laryngoscopy and CR of the dislocated arytenoid, with adjunct injection laryngoplasty or botulinum toxin administration in select cases.

MAIN OUTCOMES AND MEASURES: Initial diagnosis was confirmed using flexible laryngeal endoscopy with stroboscopy, computed tomography, electromyography, and interoperative palpation. Arytenoid motion (primary outcome measure) and vocal function data (secondary outcome measures) were collected before treatment and up to 6 months after treatment.

RESULTS: Key history features included emergent intubation, elective intubation, and external laryngeal trauma. Sixteen patients (73%) had anterior and 6 patients (27%) posterior dislocation. One patient experienced spontaneous recovery. Following CR, with or without adjunct therapy, 18 of the remaining patients (86%) exhibited arytenoid motion recovery with concomitant voice improvement. Recovery was sustained at 6 months after CR. Closed reduction performed within 21 days of the presumed dislocation event was associated with a superior arytenoid motion recovery rate.

CONCLUSIONS AND RELEVANCE: These data represent the largest clinical series on arytenoid dislocation with complete vocal function data and follow-up at 6 months after CR. These findings also corroborate existing evidence for early surgical intervention.

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