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(15): 5119-5123 [PMID: 35801012 DOI: 10.12998/wjcc.v10.i15.5119]
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. May 26, 2022; 10(15): 5119-5123 Published online May 26, 2022. doi: 10.12998/wjcc.v10.i15.5119
Delayed diagnosis of arytenoid cartilage dislocation after tracheal intubation in the intensive care unit: A case report
Weng-Qing Yan, Chen Li, Zhi Chen
Weng-Qing Yan, Medical Department of Graduate School, Nanchang University, Nanchang 330006, Jiangxi Province, China
Weng-Qing Yan, Zhi Chen, 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
Author contributions: Yan WQ reviewed the literature and contributed to manuscript drafting; Li C analyzed and interpreted the imaging findings and contributed to manuscript drafting; Chen Z were responsible for the revision of the manuscript for important intellectual content; all authors issued final approval for the version to be submitted.
Supported bythe National Natural Science Foundation of China, No. 82160020.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Received: January 11, 2022 Peer-review started: January 11, 2022 First decision: February 21, 2022 Revised: March 5, 2022 Accepted: March 26, 2022 Article in press: March 26, 2022 Published online: May 26, 2022
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.
Core Tip: We report a case of arytenoid cartilage dislocation in the intensive care unit (ICU). The main reason for delayed diagnosis was difficulty in communicating with the patient, who was under sedation. This resulted in difficulties in early observations of dislocation symptoms. Therefore, patients in the ICU may be at a greater risk for arytenoid cartilage dislocation, and it is difficult to identify these symptoms, leading to missed or delayed diagnosis.
