Page 112 - Revista Portuguesa - SPORL - Vol 60. Nº3
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Arytnoid subluxation/dislocation is caused by balanced general anesthesia with laryngeal
a disruption of the crycoarytenoid joint with mask airway (LMA) 4 ½ air-Qsp® (shown in
hoarsness being the most common symptom. Fig. 1).
It can be classified as anterior or posterior. It The block was performed under ultrasound
most commonly occurs as a result of intubation guidance while awaken. 15ml of ropivacaine
trauma but it can also be caused by external 0,5% was uneventfully injected. Endovenous
neck trauma. We present the first case of induction with fentanyl and propofol was
bilateral arytenoid dislocation after laryngeal conducted. LMA was easily inserted at first
mask intubation and its management. attempt. Anesthesia was maintained with
sevoflurane, mixed in oxygen enriched air.
Case Report Ventilation was uneventful, always less than 15
A 28-year-old male, 185 cm height and 75 cm H20, with no degradation in vital signs. The
Kg weight, ASA I, with no airway problems procedure took 3 hours in a sitting position.
expected, was submitted under general After awaking, severe hoarseness with weak,
anesthesia to open osteosynthesis of a left hoarse and breathy voice (GRBAS scale –
humerus fracture after a bike accident. Grade, Roughness, Breathiness, Aesthenia,
Anesthesia protocol was a combined Strain - 2,2,3,0,0), was observed in the post-
interscalene brachial plexus block with anesthesia care unit (PACU), without dyspnea,
stridor, cough, pain or dysphagia. Vital signs
Figura 1 were normal. The patient was discharged the
Laryngeal mask airway (LMA) 4 ½ air-Qsp® next day. Since hoarseness was still present on
reobservation after 7 days, an ENT consultation
was scheduled. There, videolaryngoscopy and
stroboscopy observation showed incomplete
glottic closure with bilateral and symmetrical
limitation of vocal fold mobility, with apparent
bilateral posterior dislocation of arytenoid
cartilages (shown in Fig. 2 with QR code for
the video). The diagnosis was confirmed with
computerized tomography (CT) showing
Figura 2
Videolaryngoscopy with apparent bilateral posterior dislocation of arytenoid cartilages. QR code for the
video
268 Revista Portuguesa de Otorrinolaringologia - Cirurgia de Cabeça e Pescoço
