Arytenoid subluxation after a bout of coughing: a rare case
Nupur Nerurkar, MS (ENT)
, Sunita Chhapola, MS (ENT), DNB, FCPS, DORL
Department of ENT, Bombay Hospital, Mumbai, Maharashtra, India
Received 19 May 2011
Abstract Korman et al (Laryngoscope.1973;83:683–690) first reported arytenoid dislocation as a rare and
unusual complication of intubation. Since then, the terms arytenoid dislocation and arytenoid
subluxation (AS) have been used interchangeably to describe disruption of the cricoarytenoid joint.
Only 74 cases of AS have been reported in the literature to date. The most common cause of AS
is intubation trauma and external neck injury. Only 1 case of AS due to coughing has been
documented. Arytenoid subluxation cases are often misdiagnosed as vocal fold paralysis. A high
index of suspicion based on the history, examination findings, and objective tests helps in early
diagnosis and, thus, early surgical intervention. We present a rare etiology of AS due to a bout of
coughing, which was diagnosed early and reduced under general anesthesia with complete rever-
sibility of vocal fold motion, thus restoring normal voice function.
© 2012 Elsevier Inc. All rights reserved.
Disruption of the cricoarytenoid joint can be complete or
partial. Arytenoid dislocation refers to complete separation
of the arytenoid cartilage from the cricoarytenoid joint space,
and it usually results from severe laryngeal trauma. Ary-
tenoid subluxation (AS) refers to a partial displacement of
the arytenoid within the joint. Literature suggests that AS is a
more common injury than arytenoid dislocation. The most
common cause is intubation or laryngeal trauma, which
results in laryngeal edema, hemorrhage, or mucosal tears.
Cough causing AS is very rare. Symptoms of dysphonia and
throat pain are mild and usually resolve in 24 to 48 hours.
Severe laryngeal injury may cause AS or recurrent laryn-
geal nerve palsy, which leads to an immobile vocal fold and
asymmetry of arytenoid cartilages. Hence, misdiagnosis is
common. A detailed history, examination, computed tomo-
graphic (CT) scan, and laryngeal electromyogram (EMG)
helps to differentiate between the 2 conditions. Early
diagnosis and surgical intervention may restore normal
2. Case report
A 45-year-old male patient presented with sudden change
of voice and throat pain since 2 days after a bout of severe
coughing. The patient had undergone an upper gastrointes-
tinal scopy 5 days back for suspected gastroesophageal
reflux disease. After gastrointestinal scopy, the patient had a
mild throat pain for which he was given medical line of
treatment and was symptomatically better. He had a severe
coughing episode 2 days later, after which he had a hoarse
breathy voice and severe throat pain. There was no other
significant medical or surgical history. The maximum pho-
nation time (MPT) was 3 seconds. A 70° rigid laryngoscopy
revealed an immobile left vocal fold, edema of the inter-
arytenoid region, and a left anteriorly tilted arytenoid car-
tilage with absent jostle phenomenon (Fig. 1), which
suggested AS. Flexible laryngoscopy also confirmed the
diagnosis. A CT scan from the base skull to upper medi-
astinum with contrast enhancement was performed. The CT
scan was suggestive of a subluxated left arytenoid in the
anterior position, asymmetry of bilateral vocal processes,
obliteration of left cricoarytenoid space, and absence of any
Available online at www.sciencedirect.com
American Journal of Otolaryngology–Head and Neck Medicine and Surgery 33 (2012) 275 – 278
Corresponding author. Department of ENT, Bombay Hospital, D-603,
Simla House, Napean Sea Road Mumbai-400026, India. Tel.: +22
22067676, +919821034085; fax: +22 22080871.
E-mail address: email@example.com (N. Nerurkar).
0196-0709/$ – see front matter © 2012 Elsevier Inc. All rights reserved.