Laryngeal EMG Is Best Technique to Differentiate Arytenoid Dislocation from Unilateral Vocal Fold Paralysis

What are the incidence, diagnosis, laryngeal findings and management of arytenoid dislocation as a separate entity from vocal fold paralysis?

Background: A rare clinical entity, arytenoid dislocation commonly presents with hoarseness, breathy voice and dysphagia. The etiology is usually intubation, direct laryngoscopy or blunt laryngeal trauma. Early diagnosis is important, but laryngoscopic findings are similar to laryngeal nerve injury, which will show decreased vocal fold activity and may show malposition of the arytenoid cartilage.

Study design: Literature review

Setting: Department of Otolaryngology and Communicative Sciences, University of Mississippi, Jackson

Synopsis: In 43 literature articles that covered 15 years, 103 patients were identified, and researchers reported on the diagnoses, treatment types and outcomes. Methods of diagnosis included videostroboscopy, EMG and CT. In most reported cases, diagnosis has been made based on the position of the arytenoid at laryngoscopy. Treatment varied between closed reduction through direct or indirect laryngoscopy, speech therapy or spontaneous resolution. Closed reduction with repositioning of the arytenoid was the most common treatment type.

Bottom line: Although arytenoid dislocation is a rare occurrence that is usually associated with laryngeal manipulation, it is important to differentiate it from vocal cord paralysis, because the treatment is different. Laryngeal EMG is probably the best technique to differentiate between the two diagnoses.

Citation: Norris BK, Schweinfurth JM. Arytenoid dislocation: an analysis of the contemporary literature. Laryngoscope. 2011;121:142-146.

—Reviewed by Sue Pondrom