382 J Nippon Med Sch 2003; 70（5）
―Photogravure―
Arytenoid Dislocation: A New Diagnostic and Treatment Approach
Hideto Saigusa, Takayuki Kokawa, Iichirou Aino, Chiharu Iwasaki,
Tsuyoshi Nakamura and Toshiaki Yagi
Department of Otolaryngology, Nippon Medical School
Fig. 1 Laryngoscopic view of dislocation of the left arytenoid cartilage（poor mobility of the
left vocal fold and incompetent glottal closure are appreciated.）: Similar findings in
recurrent laryngeal nerve palsy.
（a） during inspiration,（b）during phonation
Fig. 2 Video-fluorography finding（upward hypermobility of the left vocal fold during
phonation）
（a） during inspiration,（b）
during phonation
Fig. 3 The procedure for the electromyogra-
phic examination to the intrinsic lary-
ngeal muscle via crico-thyroid mem-
brane
E-mail: s-hideto@[Link]
Journal Website（http:! ![Link]!
jnms!
）
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J Nippon Med Sch 2003; 70（5） 383
Fig. 4 Electromyography of the left thyro-arytenoid muscle during phonation（normal
action potential in the case of the arytenoid dislocation）
.
Fig. 5 Closed reduction of the arytenoid dislocation under the direct laryngoscopy
with the laryngeal forceps.
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Dislocation（subluxation）of the arytenoid cartilage is an unusual injury that can occur following blunt
trauma or medical instrumentation to the laryngeal cavity（e.g. endotracheal intubation）1. The signs and
symptoms may include hoarseness, aphonia, dysphagia, aspiration, and odynophagia. The diagnosis has usually
been made clinically and with the use of a laryngoscope. However, neurogenic arytenoids cartilage
dysfunction such as recurrent laryngeal nerve palsy also presents very similar signs and symptoms and is
difficult to rule out by routine evaluation（Fig. 1） . Additionally, for those with actual arytenoid cartilage
dislocation, the method of reduction has not been well established. The effective diagnostic protocol and the
reduction technique used for arytenoid cartilage dislocation, which we originally developed, are described.
Our diagnostic protocol consists of video-fluorography and electromyography of the intrinsic laryngeal
muscle during phonation 2,3. Video-fluorography revealed upward hypermobility of the vocal fold on the
dislocated side during phonation. Poor mobility was found on the vocal fold which was affected by recurrent
laryngeal nerve palsy（Fig. 2） . Electromyography of the intrinsic laryngeal muscle shows almost normal action
potential in the case of arytenoid dislocation（Fig. 3, 4）, while aberrant action potential was found for a subject
with recurrent laryngeal nerve palsy.
The closed reduction of arytenoid cartilage dislocation was successfully performed with direct
laryngoscopy under conscious sedation and local anesthesia without endotracheal intubation. Our technique
for the reduction of arytenoid dislocation is performed with both posterior-lateral pressure to the arytenoid
cartilage on the affected side by laryngoscopic forceps（Fig. 5）and opposing medial pressure on the cricoid
cartilage percutaneously.
References
1．Sataloff RT: Arytenoid Dislocation. Laryngoscope 1994; 104: 1353―1361.
2．Saigusa H, et al: A Device for Arytenoid Subluxation in Thyroplasty（type I）
. J Jpn Bronchoesophageal
Soc. 1996; 47: 539―544,
3．Hoffman HT, et al: Arytenoid Subluxation: Diagnosis and Treatment. Ann Otol Rhinol Laryngol 1991; 100:
1―9.
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