Page 114 - Revista Portuguesa - SPORL - Vol 60. Nº3
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to dislocation. Also, device rotation during arthrodial joint that allows gliding, rocking and
placement, with folding into the larynx rotation movements and is moved by several
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vestibule, pressing the arytenoids from above intrinsic laryngeal muscles. In our mind, the
might cause posterior and inferior dislocation. fact that we find so few cases in the literature
Unlike for endotracheal intubation, where we is due to a good prognosis and to a high rate
find mostly unilateral dislocations , here we of self-resolution — the intrinsic laryngeal
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presume the symmetrical trauma to be the muscle ensemble helps to reposition the sub-
rule, and therefore we should find, more often luxated cartilages, and therefore voice therapy
than not, bilateral dislocations. This symmetry, is helpful. We also consider that cartilage direct
in turn, makes endoscopic diagnosis more manipulation may lead to further dislocation
difficult and may be a reason for the scarcity or dislocation on the opposite direction, mostly
of published cases. because correct directional diagnosis is so
We suggest that the risk of arytenoid difficult . Additionally, it may also add capsule
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dislocation should integrated in the informed stretching and even mucosal or cartilage
consent given by Anesthesiologists and injury, making prognosis worse. So, an early
any difficulty during intubation should be intervention with voice therapy may solve at
communicated to the ENT surgeon for further least some of these rare cases. For those that
evaluation. are not showing any signs of recovering, closed
The most common symptom of this reduction may be attempted. This delay in
complication is hoarseness. A clear diagnosis close reduction is acceptable 10,11 and it showed
is always difficult, because endoscopic aspects better results when performed until 10 weeks
overlap with postintubation oedema, and after the injury .
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paralysis from nerve trauma, and furthermore, Closed reduction is performed under local
the direction of the dislocation is also difficult anesthesia with the patient sedated . Normally,
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to determine, because the superior portion a posterior dislocation can be achieved using
of the cartilage may not follow the body a straight-bladed laryngoscope to lift the
dislocation . We believe, stroboscopy in the arytenoid anterosuperiorly as described
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eyes of an experienced otolaryngologist elsewhere . External cricoid pressure may be
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makes diagnosis easier. Most of the times, helpful. Anterior dislocation is reduced using
especially in younger patients, laryngeal an Holinger laryngoscope (used in laryngeal
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cartilages are not mineralized, and are not microsurgery).
radio-opaque, which makes imaging studies Some cases will not be successful and
inconclusive . A nondiagnostic CT scan does eventually evolve to chronicity and may
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not exclude the diagnosis . In our patient, CT or may not need adjuvant phonosurgical
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scan was suggestive of posterior dislocation, procedures, such as vocal cord injection or
with a reduced cricoarytenoid joint space. laryngeal framework surgery (Thyroplasty and
An electromyography of the laryngeal arytenoid abduction/aduction).
musculature could have been helpful in Open surgical reductions (via laringofissure
confirming the normal innervation of the for example) are normally used in cases
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larynx (excluding nerve paralysis for example), of external trauma where other lesions are
especially if there was an uncertainty about normally present.
the diagnosis. Fortunately, our patient was offered voice
Early diagnosis allows early treatment, which therapy three sessions per week, with success
is preferred and presumed to bring better in less than a month
prognosis. Several treatment modalities have
been published, from voice therapy, closed Conclusion
reduction, open approaches and botulinum Hoarseness is usually a frequent and benign
toxin injection . The crico-arytenoid joint is an sign after airway intubation. LMA is a very
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270 Revista Portuguesa de Otorrinolaringologia - Cirurgia de Cabeça e Pescoço
