Anterior arytenoid cartilage dislocation, a rare complication of esophagogastroduodenoscopy

Arytenoid cartilage dislocation is a rare complication after tracheal intubation, occurring in less than 0.1 % of cases [1] [2]. Here we present a case of arytenoid cartilage dislocation following esophagogastroduodenoscopy (EGD). A man in his sixties underwent EGD as a follow-up examination after endoscopic treatment for early gastric cancer. The examination was carried out with a standard endoscope (GIFH260, Olympus, Tokyo, Japan), under conscious sedation with midazolam (3 mg) and pethidine chloride (35 mg), and was completed uneventfully. After a 1-hour rest in the recovery unit, the patient developed aphonia without any throat pain. Following treatment with dequalinium chloride troches, the patient still had persisting hoarseness and difficulty swallowing 4 days later. Laryngoscopy showed anterior dislocation of the left arytenoid cartilage, with a flaccid and fixed left vocal cord ([Fig. 1]). Fiberscopic reduction was carried out as an ambulatory procedure, under local anesthesia, and reposition was confirmed on the following day ([Fig. 2]). The dysphonia and vocal cord movement improved gradually over the next 2 weeks ([Fig. 3]).

Fig. 1 Laryngoscopic view of the anterior dislocation (blue arrows) of the left arytenoid cartilage four days after esophagogastroduodenoscopy (EGD) in an older man.

Fig. 2 The repositioned arytenoid cartilage 1 day after fiberscopic reduction.

Fig. 3 There was gradual improvement in the dysphonia and vocal cord movement over the next 2 weeks.

Arytenoid cartilage dislocation presents with hoarseness, dysphagia, throat pain, and stridor. Direct visualization of cricoarytenoid dislocation by laryngoscopy is useful, and early recognition directly impacts treatment success [3]. Only one case of arytenoid dislocation following EGD has been reported in the literature [4], and the incidence of this rare complication is unknown. Endoscopists should be mindful of arytenoid dislocation occurring as a complication after EGD.

Endoscopy_UCTN_Code_CPL_1AH_2AB

• References

• 1 Yamanaka H, Hayashi Y, Watanabe Y et al. Prolonged hoarseness and arytenoid cartilage dislocation after tracheal intubation. Br J Anaesth 2009; 103: 452-455
• 2 Szigeti C, Baeuerle J, Mongan P. Arytenoid dislocation with lighted stylet intubation: Case report and retrospective review. Anesth Analg 1994; 78: 185-186
• 3 Sataloff RT, Bough ID, Spiegel JR. Arytenoid dislocation: diagnosis and treatment. Laryngoscope 1994; 104: 1353-1361
• 4 Afonso A, Woo P, Reed A. Arytenoid dislocation following upper gastrointestinal endoscopy. Endoscopy 2011; 43: E368