1
|
Jiang T, Fang B, Yu Z, Cao D. Hoarseness and arytenoid dislocation: A rare complication after facial bony contouring surgery. J Plast Reconstr Aesthet Surg 2023; 84:432-438. [PMID: 37413735 DOI: 10.1016/j.bjps.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/28/2023] [Accepted: 06/05/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Arytenoid dislocation is a rare complication after endotracheal intubation and may result in permanent hoarseness, which cannot be tolerated during cosmetic surgeries, such as facial bony contouring surgery. This study aimed to identify the clinical characteristics of this patient subgroup and share the process of diagnosis and treatment. METHODS We retrospectively collected the medical records of patients who underwent facial bony contouring surgery under general anesthesia with endotracheal intubation from September 2017 to July 2022. We divided the patients into a nondislocation group and a dislocation group. Demographic, anesthetic, and surgical characteristics were collected and compared. RESULTS 441 patients were enrolled, and 5 (1.1%) were diagnosed with arytenoid dislocation. The patients in the dislocation group were more likely to be intubated with the video laryngoscope (P = 0.049), and head-neck movement during surgery may predispose patients to arytenoid dislocation (P = 0.019). The patients in the dislocation group were diagnosed around 5-37 days after surgery. Three of them regained their normal voice after close reduction, and two recovered with speech therapy. CONCLUSION Arytenoid dislocation may result from multiple factors instead of one high-risk factor. Head-neck movement, the skills and experience of anesthetists, the time of intubation, and the use of intubation tools may all predispose patients to arytenoid dislocation. To acquire timely diagnosis and treatment, patients should be fully informed of this complication before surgery and observed closely afterward. Any postoperative voice or laryngeal symptoms lasting more than 7 days need a specialist evaluation.
Collapse
Affiliation(s)
- Taoran Jiang
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Zhizaoju Road 639, Shanghai 200011, PR China
| | - Bin Fang
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Zhizaoju Road 639, Shanghai 200011, PR China
| | - Zheyuan Yu
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Zhizaoju Road 639, Shanghai 200011, PR China.
| | - Dejun Cao
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Zhizaoju Road 639, Shanghai 200011, PR China.
| |
Collapse
|
2
|
Yan W, Chen Z, Dong W, Qian Y. High prevalence of postoperative arytenoid dislocation in patients undergoing liver transplantation: A case-control study. Medicine (Baltimore) 2023; 102:e34771. [PMID: 37653787 PMCID: PMC10470738 DOI: 10.1097/md.0000000000034771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 09/02/2023] Open
Abstract
Arytenoid dislocation (AD) is a rare complication of surgery under general anesthesia. The potential factors for AD remain poorly defined, and the identification of risk factors is beneficial for reducing its incidence. We found that patients undergoing liver transplantation appeared to be more susceptible to postoperative AD at our hospital. The present study was designed to clarify this issue. A retrospective hospital-based case-control study was conducted in patients undergoing surgery under general anesthesia between 2017 and 2021. Recorded data for all patients were age, sex, body weight, height, body mass index, position of patients during surgery, duration of surgery, emergency status of surgery, and liver transplantation. Logistic regression analysis was performed to determine risk factors for AD. Thirty thousand one hundred fifty-four patients who underwent general anesthesia between 2017 and 2021 were included. Sixteen (0.05%) patients were diagnosed with AD, including 10 (3.9%) patients among 259 patients who underwent liver transplantation and 6 patients had complications among the 29,895 patients who underwent other operations (P < .0001). Postoperative AD incidence was significantly elevated in patients undergoing liver transplantation. This finding should be clinically relevant and alarming for anesthesiologists and clinicians to help avoid arytenoid dislocation and improve patient outcomes. Further studies that incorporate detailed data are needed to determine risk factors for AD.
Collapse
Affiliation(s)
- Wenqing Yan
- Department of Emergency, Jiangxi Provincial People’s Hospital, Nanchang, Jiangxi, China
- The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Zhi Chen
- Department of Emergency, Jiangxi Provincial People’s Hospital, Nanchang, Jiangxi, China
- The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Weihua Dong
- Department of Emergency, Jiangxi Provincial People’s Hospital, Nanchang, Jiangxi, China
- The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Yihong Qian
- Department of Anesthesiology, Jiangxi Provincial People’s Hospital, Nanchang, Jiangxi, China
- The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| |
Collapse
|
3
|
Hung KC, Chang YJ, Chang YP, Ho CN, Lan KM, Chen JY, Wang LK, Huang PW, Sun CK. The impact of esophageal device insertion on cuff pressure of endotracheal tube: a literature review and meta-analysis. Sci Rep 2022; 12:18192. [PMID: 36307502 PMCID: PMC9616852 DOI: 10.1038/s41598-022-21980-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 10/07/2022] [Indexed: 12/31/2022] Open
Abstract
The impact of intraoperative esophageal device insertion (EDI) on endotracheal tube (ET) cuff inflation pressure remains unclear. Electronic databases including Medline, Embase, Google scholar, Web of Science™ and Cochrane Central Register of Controlled Trials were searched for studies involving EDI after placement of ETs from inception to July 7, 2022. The primary outcome was risk of high cuff pressure, while the secondary outcomes were increases in cuff pressure following EDI. Difference between adults and children was investigated with subgroup analysis. There were ten eligible studies (observation study, n = 9, randomized controlled study, n = 1) involving a total of 468 participants. EDI notably increased the risk of high cuff pressure (n = 7, risk ratio: 12.82, 95% confidence interval: 4.9 to 33.52, subgroup analysis: p = 0.008). There were significant elevations in cuff pressure in adults and children both during (13.42 and 7.88 cmH2O, respectively, subgroup analysis: p = 0.15) and after (10.09 and 3.99 cmH2O, respectively, subgroup analysis: p = 0.0003) EDI. Our results revealed an over 12-fold increase in the risk of high endotracheal tube cuff pressure in patients, especially adults, receiving EDI under endotracheal anesthesia. There were significant increases in both adults and children despite a higher increase in the former after device insertion.
Collapse
Affiliation(s)
- Kuo-Chuan Hung
- grid.413876.f0000 0004 0572 9255Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan ,grid.411315.30000 0004 0634 2255Department of Hospital and Health Care Administration, College of Recreation and Health Management, Chia Nan University of Pharmacy and Science, Tainan City, Taiwan
| | - Ying-Jen Chang
- grid.413876.f0000 0004 0572 9255Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan ,grid.411315.30000 0004 0634 2255Department of Recreation and Health-Care Management, College of Recreation and Health Management, Chia Nan University of Pharmacy and Science, Tainan City, Taiwan
| | - Yang-Pei Chang
- grid.412019.f0000 0000 9476 5696Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan ,grid.412027.20000 0004 0620 9374Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Chun-Ning Ho
- grid.413876.f0000 0004 0572 9255Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
| | - Kuo-Mao Lan
- grid.413876.f0000 0004 0572 9255Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
| | - Jen-Yin Chen
- grid.413876.f0000 0004 0572 9255Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
| | - Li-Kai Wang
- grid.413876.f0000 0004 0572 9255Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan ,grid.411315.30000 0004 0634 2255Department of Hospital and Health Care Administration, College of Recreation and Health Management, Chia Nan University of Pharmacy and Science, Tainan City, Taiwan
| | - Ping-Wen Huang
- grid.452796.b0000 0004 0634 3637Department of Emergency Medicine, Show Chwan Memorial Hospital, Changhua City, Taiwan
| | - Cheuk-Kwan Sun
- grid.414686.90000 0004 1797 2180Department of Emergency Medicine, E-Da Hospital, No.1, Yida Road, Jiaosu Village, Yanchao District, Kaohsiung City, 82445 Taiwan ,grid.411447.30000 0004 0637 1806College of Medicine, I-Shou University, Kaohsiung City, Taiwan
| |
Collapse
|
4
|
Yan WQ, Li C, Chen Z. Delayed diagnosis of arytenoid cartilage dislocation after tracheal intubation in the intensive care unit: A case report. World J Clin Cases 2022; 10:5119-5123. [PMID: 35801012 PMCID: PMC9198865 DOI: 10.12998/wjcc.v10.i15.5119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/05/2022] [Accepted: 03/26/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Arytenoid cartilage dislocation is a rare and often overlooked complication of tracheal intubation or blunt laryngeal trauma. The most common symptom is persistent hoarseness. Although cases of arytenoid dislocation due to tracheal intubation are reported more frequently in otolaryngology, reports on its occurrence in the intensive care unit (ICU) are lacking. We report a case of delayed diagnosis of arytenoid cartilage dislocation after tracheal intubation in the ICU.
CASE SUMMARY A 20-year-old woman was referred to the ICU following a fall from a height. Her voice was normal; laryngeal computed tomography showed unremarkable findings on admission. However, due to deterioration of the patient’s condition, tracheal intubation, and emergency exploratory laparotomy followed by laparoscopic surgery two d later under general anesthesia were performed. After extubation, the patient was sedated and could not communicate effectively. On the 10th day after extubation, the patient complained of hoarseness and coughing with liquids, which was attributed to laryngeal edema and is common after tracheal intubation. Therefore, specific treatment was not administered. However, the patient’s symptoms did not improve. Five d later, an electronic laryngoscope examination revealed dislocation of the left arytenoid cartilage. The patient underwent arytenoid closed reduction under general anesthesia by an experienced otolaryngologist. Reported symptoms improved subsequently. The six-month follow up revealed that the hoarseness had resolved within four weeks of the reduction procedure.
CONCLUSION Symptoms of arytenoid cartilage dislocation are difficult to identify in the ICU leading to missed or delayed diagnosis among patients.
Collapse
Affiliation(s)
- Weng-Qing Yan
- Medical Department of Graduate School, Nanchang University, Nanchang 330006, Jiangxi Province, China
- Department of Emergency, Jiangxi Provincial People’s Hospital, Nanchang 330006, Jiangxi Province, China
| | - Chen Li
- Department of Traumatology, Jiangxi Provincial People’s Hospital, Nanchang 330006, Jiangxi Province, China
| | - Zhi Chen
- Department of Emergency, Jiangxi Provincial People’s Hospital, Nanchang 330006, Jiangxi Province, China
| |
Collapse
|
5
|
Jang EA, Yoo KY, Lee S, Song SW, Jung E, Kim J, Bae HB. Head-neck movement may predispose to the development of arytenoid dislocation in the intubated patient: a 5-year retrospective single-center study. BMC Anesthesiol 2021; 21:198. [PMID: 34330223 PMCID: PMC8325301 DOI: 10.1186/s12871-021-01419-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/30/2021] [Indexed: 11/17/2022] Open
Abstract
Background Arytenoid dislocation is a rare laryngeal injury that may follow endotracheal intubation. We aimed to determine the incidence and risk factors for arytenoid dislocation after surgery under general anaesthesia. Methods We reviewed the medical records of patients who underwent operation under general anaesthesia with endotracheal intubation from January 2014 to December 2018. Patients were divided into the non-dislocation and dislocation groups depending on the presence or absence of arytenoid dislocation. Patient, anaesthetic, and surgical factors associated with arytenoid dislocation were determined using Poisson regression analysis. Results Among the 25,538 patients enrolled, 33 (0.13%) had arytenoid dislocation, with higher incidence after anterior neck and brain surgery. Patients in the dislocation group were younger (52.6 ± 14.4 vs 58.2 ± 14.2 yrs, P = 0.025), more likely to be female (78.8 vs 56.5%, P = 0.014), and more likely to be intubated by a first-year anaesthesia resident (33.3 vs 18.5%, P = 0.048) compared to those in the non-dislocation group. Patient positions during surgery were significantly different between the groups (P = 0.000). Multivariable Poisson regression identified head-neck positioning (incidence rate ratio [IRR], 3.10; 95% confidence interval [CI], 1.50–6.25, P = 0.002), endotracheal intubation by a first-year anaesthesia resident (IRR, 2.30; 95% CI, 1.07–4.64, P = 0.024), and female (IRR, 3.05; 95% CI, 1.38–7.73, P = 0.010) as risk factors for arytenoid dislocation. Conclusion This study showed that the incidence of arytenoid dislocation was 0.13%, and that head-neck positioning during surgery, less anaesthetist experience, and female were significantly associated with arytenoid dislocation in patients who underwent surgeries under general anaesthesia with endotracheal intubation.
Collapse
Affiliation(s)
- Eun-A Jang
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Chonnam National University Hospital, 160, Baekseo-ro, Dong-gu, Gwangju, 501 746, Korea
| | - Kyung Yeon Yoo
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Chonnam National University Hospital, 160, Baekseo-ro, Dong-gu, Gwangju, 501 746, Korea
| | - Seongheon Lee
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Chonnam National University Hospital, 160, Baekseo-ro, Dong-gu, Gwangju, 501 746, Korea
| | - Seung Won Song
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Chonnam National University Hospital, 160, Baekseo-ro, Dong-gu, Gwangju, 501 746, Korea
| | - Eugene Jung
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Chonnam National University Hospital, 160, Baekseo-ro, Dong-gu, Gwangju, 501 746, Korea
| | - Joungmin Kim
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Chonnam National University Hospital, 160, Baekseo-ro, Dong-gu, Gwangju, 501 746, Korea.
| | - Hong-Beom Bae
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Chonnam National University Hospital, 160, Baekseo-ro, Dong-gu, Gwangju, 501 746, Korea.
| |
Collapse
|
6
|
Frosolini A, Marioni G, Maiolino L, de Filippis C, Lovato A. Current management of arytenoid sub-luxation and dislocation. Eur Arch Otorhinolaryngol 2020; 277:2977-2986. [PMID: 32447498 DOI: 10.1007/s00405-020-06042-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 05/08/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To review the current management of arytenoid subluxation/dislocation (AS/AD) focusing on diagnostic, therapeutic, and prognostic controversies. METHODS The international literature of the last 20 years has been considered. After the application of inclusion criteria, 20 studies were selected (471 AS/AD cases in total). RESULTS All the included investigations were retrospective case series. AS/AD was often iatrogenic occurring at least in 0.01% of patients undergone endo-tracheal intubation. The most common symptom was persistent hoarseness. The diagnosis was made by video-laryngoscopy and neck computed tomography in most reports, while some used also laryngeal electromyography. Laryngeal electromyography was fundamental to rule out unilateral vocal fold paralysis, the main differential diagnosis. The surgical relocation of AS/AD under general or local anesthesia was achieved in about 80% of patients. CONCLUSION AS/AD is a mechanical disorder of the larynx that can be successfully treated if promptly diagnosed. Clinical trials and multi-centric studies are necessary to set management guidelines.
Collapse
Affiliation(s)
- Andrea Frosolini
- Audiology Unit at Treviso Hospital, Department of Neuroscience DNS, University of Padova, Piazzale Ospedale 1, 31100, Treviso, Italy
| | - Gino Marioni
- Otolaryngology Unit, Department of Neuroscience DNS, University of Padova, Padova, Italy
| | - Luigi Maiolino
- ENT Section, Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, Catania, Italy
| | - Cosimo de Filippis
- Audiology Unit at Treviso Hospital, Department of Neuroscience DNS, University of Padova, Piazzale Ospedale 1, 31100, Treviso, Italy
| | - Andrea Lovato
- Audiology Unit at Treviso Hospital, Department of Neuroscience DNS, University of Padova, Piazzale Ospedale 1, 31100, Treviso, Italy.
| |
Collapse
|