Clinical features of arytenoid dislocation after endotracheal intubation: a 3-year retrospective single-center study

Background: Arytenoid dislocation (AD), a rare laryngeal injury that may follow endotracheal intubation, requires systematic characterization. We aimed to review the clinical features of AD after the endotracheal intubation and evaluate the treatment timing and vocal outcomes. Methods: We reviewed the medical records of patients who underwent operation under general anesthesia with endotracheal intubation from January 2022 to December 2024. Patient, anesthetic, and surgical factors associated with AD were analyzed. Results: A total of 29 patients with AD were identified. The patients had undergone the endotracheal intubation for abdominal surgery (n=19), video-assisted thoracoscopic surgery (n=4), head and neck surgery (n=3), and cardiac surgery (n=3). A total of 11 patients were intubated by the resident anesthetist and 18 patients by the staff anesthetist. An intraoperative nasogastric tube or transesophageal echocardiography probe was placed in 75.9% of patients. The operation time ranged between 105 and 626 minutes with a mean of 264.7 ± 126.0 minutes. The most common symptom was hoarseness (n=21), followed by dysphagia (n=7), odynophagia (n=3). Left-sided dislocation observed in 20 (67.0%) cases. Closed reduction was performed as first-line therapy in confirmed AD cases. The time from primary surgical intervention to closed reduction was 9.9 ± 10.5 days. Although there was no significant association between treatment timing and vocal recovery categories, closed reduction intervention within the critical 7-day window achieved the improved vocal outcomes (66.7%) higher than delayed intervention (37.5%). Conclusions: This study indicates that AD after the endotracheal intubation featured by prolonged surgical duration (>180 minutes), abdominal surgery, and concurrent nasogastric tube or transesophageal echocardiography probe placement. Even if there is no significant association between treatment timing and vocal recovery, we recommend earlier intervention.