A Case of Anterior Arytenoid Cartilage Dislocation During Nasal Tracheal Intubation Using an Indirect Video Laryngoscope

Abstract

Arytenoid cartilage dislocation can occur as a complication of tracheal intubation and laryngeal trauma, but its occurrence with indirect video laryngoscopy has not been reported. This paper reports anterior arytenoid dislocation occurring after nasotracheal intubation performed under indirect laryngoscopy using a video laryngoscope (McGRATH MAC; Medtronic). The dislocation is presumed to have resulted from the laryngoscope blade being initially inserted too deeply and applying pressure to the posterior aspect of the left cricoarytenoid joint. This patient's anterior arytenoid dislocation was treated conservatively using speech therapy with resolution occurring approximately 40 days postoperatively. On the 74th day after surgery, fibroscopic examination confirmed recovery and healing of the dislocation. However, other types of arytenoid dislocations and laryngeal injuries may require alternative treatment. Early consultation with an otolaryngologist is recommended if arytenoid dislocation is suspected.

Keywords: Arytenoid cartilage dislocation; General anesthesia; Hoarseness; Indirect laryngoscopy; Tracheal intubation; Video laryngoscope.

Figure 1.

Postoperative Computed Tomography Imaging (A) Sagittal view of the left cricoarytenoid joint reveals a gap (red circle) between the arytenoid and cricoid cartilages due to the arytenoid dislocation. (B) Sagittal view of the right cricoarytenoid joint illustrates the arytenoid and cricoid cartilages are contacting (red circle). (C) Axial view shows the left arytenoid cartilage is displaced anteromedially (arrow).

Figure 2.

Laryngeal Anatomy and the Video Laryngoscope Tip (A) The tip of the video laryngoscope blade may have been initially inserted too deeply and compressed the posterior aspect of the cricoarytenoid joint. (B) A 3-D diagram of the laryngeal structures illustrating where a strong force is presumed to have been exerted on the left (black circle).