This case report describes a right arytenoid dislocation after emergency fiberoptic nasotracheal intubation in a patient with angioedema. The patient returned to the emergency department multiple times with classic symptoms of arytenoid dislocation, complicated by resultant postinjury laryngeal edema and poorly controlled laryngopharyngeal reflux. The arytenoid injury was not initially recognized, which delayed treatment. Several months later, intraoperative assessment was done because of continued symptoms suspicious for laryngeal injury, resulting in a diagnosis of right cricoarytenoid joint fixation resulting from prior intubation trauma. Because of delayed diagnosis and treatment, severe cricoarytenoid joint scarring and fixation prevented repositioning of the arytenoid and improvement in laryngeal function. Discussion of this case includes a review of the anatomy and function of the arytenoid and cricoarytenoid joint, along with factors that increase and decrease joint stability and risk of injury. The etiology of arytenoid dislocation is described, along with suspected mechanisms of injury in anterior vs posterior and right vs left dislocations. Classic symptoms, the importance of early identification, and treatment options are also discussed.

OBJECTIVE: This anatomic study considers the feasibility of a posterior endoscopic approach to the cricoarytenoid joint (CAJ) by describing relationships between readily identifiable anatomic landmarks and the posterior CAJ space in cadaver larynges.
METHODS: Anatomic study.
METHODS: Six adult cadaver larynges (2 male, 4 female) were studied. Digital calipers were used for measurements, and Image J software was used for angle calculations. All cricoarytenoid joints were injected with colored gel via a posterior approach using a 27-gauge needle.
RESULTS: The average age of the larynges studied was 78.7 ± 10 years. The average posterior CAJ space (pCAJs) length measured 4.95 ± 0.9 mm. The average distance from the superior aspect of the midline cricoid lamina (MCL) to the center of pCAJs and the corniculate cartilage (CC) to the center of the pCAJs were 8.35 ± 1.5 mm and 14.54 ± 1.9 mm, respectively. The average pCAJs angle of declination (AD) from the horizontal plane was 54° ± 6.2°. All 12 cricoarytenoid joints were successfully injected with colored gel via a posterior approach.
CONCLUSIONS: The posterior CAJ space can be located surgically using readily identifiable anatomic landmarks. An understanding of this posterior CAJ anatomy may allow for more consistent intra-articular injection and support the development of other CAJ procedures for a range of disorders of vocal fold motion or malposition.

Lateralizzazione mediante sutura e rilascio aritenoideo per il trattamento dell’immobilità cordale bilaterale con fissazione meccanica.
UNASSIGNED: La lateralizzazione mediante sutura al posto dell’ablazione di tessuto endolaringeo per via endoscopica è una procedura utilizzata per trattare la paralisi cordale bilaterale fin dal 1980. Tuttavia, la fissazione meccanica dell’articolazione cricoaritenoidea ha continuamente contrastato l’efficacia della dilatazione glottica, sia nella procedura di lateralizzazione mediante sutura che nell’ exeresi di tessuto endolaringeo. Dal 2007 al 2015, un totale di 38 pazienti con paralisi cordale bilaterale sono stati sottoposti a 40 lateralizzazioni mediante sutura eso-endolaringea (exoeSL) e 3 di questi pazienti hanno avuto diagnosi di fissità meccanica nel nostro ospedale. Abbiamo introdotto un approccio esterno per rilasciare la giunzione cricoaritenoidea seguito da una procedura exoeSL simile. Questa procedura di rilascio della giunzione cricoaritenoidea ha permesso la preservazione della mucosa endolaringea, risparmiando quindi l’utilizzo della chirurgia laser. Tutte e tre le procedure di rilascio della giunzione cricoaritenoidea hanno portato a decannulazione (1 paziente) o a un miglioramento della dispnea (2 pazienti). La differenza tra la lateralizzazione exoeSL e endo esolaringea saranno quindi discusse in base all’ efficacia nel trattamento della fissità meccanica.
A suture lateralisation (SL) instead of an endolaryngeal tissue ablation procedure under endoscopy has been utilised to treat bilateral vocal fold immobility (BVFI) since 1980. However, mechanical fixation (MF) of the cricoarytenoid joint (CAJ) has continually challenged the effectiveness of glottic dilatation both in the SL procedure and the tissue ablation procedure. From 2007 to 2015, a total of 38 patients with BVFI underwent 40 exo-endolaryngeal suture lateralisation (exoeSL) procedures and three were diagnosed with MF in our hospital. For these MF, we introduced an external approach method to release the CAJ followed by a similar exoeSL procedure. The CAJ release procedure enabled the preservation of the endolaryngeal mucous membrane (ELM) and consequently spared the use of laser surgery. All three CAJ release procedures led to decannulations (one patient) or improvement of dyspnoea (two patients). The difference between the exoeSL and the endo-exolaryngeal suture lateralisation (endoeSL) procedure is discussed based on their effectiveness in MF management.