Incidental Diagnosis of Pediatric Arytenoid Cartilage Dislocation During Videofluoroscopic Swallowing Study: A Case Report

Abstract

Arytenoid cartilage dislocation is one of the most common mechanical causes of vocal fold immobility. The most common etiologies are intubation and external trauma, but its incidence is lower than 0.1%. Its symptoms include dysphonia, vocal fatigue, loss of vocal control, breathiness, odynophagia, dysphagia, dyspnea, and cough. Although there are some reports of arytenoid cartilage dislocation in adults, there are only few reports on its occurrence in children. It is particularly difficult to detect the symptoms of arytenoid cartilage dislocation in uncooperative pediatric patients with brain lesions without verbal output or voluntary expression. We report a case of arytenoid cartilage dislocation with incidental findings in a videofluoroscopic swallowing study performed to evaluate the swallowing function.

Keywords: Arytenoid cartilage; Fluoroscopy; Hypoxic ischemic encephalopathy.

Fig. 1.

A diffusion-weighted magnetic resonance imaging images taken 2 weeks after the event showed increased signal intensity in bilateral occipital lobes, thalamus and basal ganglia (A). A T2-weighted FLAIR image taken 3 months after the event showed diffused cerebral atrophy of thalamus and basal ganglia, and encephalomalacia of bilateral occipital lobes (B).

Fig. 2.

The arytenoid cartilage in the videofluoroscopic swallowing study (VFSS) shows airway obstruction during inspiration (A) and opening during expiration (B). After 1 month of observation, the anterior dislocation of arytenoid cartilage was alleviated on the VFSS (C).

Fig. 3.

On the laryngoscope, anterior dislocation of arytenoid cartilage (arrow) during inspiration induces airway obstruction (A) and opening during expiration (B).