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Re: postintubation cricoarytenoid joint dysfunction
- Ikuomi Mikuni (11 October 2007)
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postintubation cricoarytenoid joint dysfunction
- jithesh appukutty (28 September 2007)
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Ikuomi Mikuni
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Thank you for your reply, and I am sorry for this late reply. Although double lumen tube is a main airway device for differential lung ventilation, our concern is that double lumen tube causes arytenoid cartilage dislocation easily because of its large outer diameter, widening at the tracheal lumen orifice, and material stiffness. The characteristics of double lumen tube may apply an unexpected external force to an arytenoid cartilage and induce arytenoid cartilage dysfunction. Additionally, there is a possibility that the failure in the first attempt of intubation influences arytenoid cartilages and cricoarytenoid joint. Anyway, it is important to conduct tests early to diagnose arytenoid cartilage dysfunction in the case of persistent hoarseness following the use of a double lumen tube. Conflict of Interest:None declared |
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jithesh appukutty
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We had a similar experience with one of our patient, a 20 year old female who had undergone antero lateral decompression of D4 to D6 spine. The intubation using the double lumen tube was unremarkable except for the failure in first attempt. Post extubation the patient had hoarseness of voice. On the first post operative day the patient went into respiratory failure and had to be supported with mechanical ventilation. A fiber optic bronchoscopy revealed gross hyperemia of glottis and the arytenoids. A diagnosis of glottic edema was made. The patient was managed with steroids and on fifht post operative day again extubated. A few hours later the patient had to be reintubated due to respiratory failure. A CT scan of the neck was done which was unremarkable. A repeat fiber optic bronchoscopy was done which revealed hyperemia of glottis with swelling of the arytenoids. A repeat bronchoscopy on 8th post operative day showed no hyperemia in glottic region but the aytenoids were still swollen. A 70 degree scopy was done post extubation which showed sluggish movement of both vocal cords. A month later the patient has some residual hoarseness. This prompted the diagnosis of postintubation cricoarytenoid joint dysfunction probably following hemarthrosis of cricoarytenoid joint. Laryngeal edema was a strong possibility but the delay in onset of respiratory distress and the persistence of hoarseness for nearly a month favored the diagnosis of CAJ dysfunction. Our experience with the patient has prompted us to give serious throught to any patient who complaints of post operative hoarsness Conflict of Interest:None declared |
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