Abstract
Arytenoid subluxation is a well-known cause of hoarseness due to incomplete glottic closure with intact inferior laryngeal nerves after severe laryngeal trauma. We report the case of a young man presenting after laryngeal blunt trauma with hoarseness, easy fatigue during phonation, marked difficulty with his high-pitch and singing voice and decreased phonation time, but intact function of both inferior laryngeal nerves, intact endolaryngeal mucosa sensibility and normal CT scans of the larynx and the neck. Due to the asymmetric anteromedial position of the right arytenoid with incomplete glottic closure, the primary diagnosis was arytenoid subluxation, and the patient was referred for instantaneous relocation therapy. The stroboscopic and electromyographic diagnosis of a unilateral paresis of the external branch of the right superior laryngeal nerve caused the therapy to be changed. Without repositioning, the patient had a total recovery of voice quality when the paresis receded 2 months later. In conclusion, the unilateral paresis of the external branch of the superior laryngeal nerve after laryngeal blunt trauma is reported here for the first time. Although the clinical findings are familiar sequelae of thyroid surgery, they may be misdiagnosed as arytenoid subluxation after laryngeal blunt trauma. Stroboscopy and electromyography permitted the correct diagnosis.
Similar content being viewed by others
References
Bellantone R, Boscherini M, Lombardi CP, Bossola M, Rubino F, De Crea C, Alesina P, Traini E, Cozza T, D'alatri L (2001) Is the identification of the external branch of the superior laryngeal nerve mandatory in thyroid operation? Results of a prospective randomized study. Surgery 130: 1055–1059
Brademann G, Reker U (1998) Paralysis of the superior laryngeal nerve after whiplash trauma. Laryngorhinootologie 77: 3–6
Eckley CA, Sataloff RT, Hawkshaw M, Spiegel JR, Mandel S (1998) Voice range in superior laryngeal nerve paresis and paralysis. J Voice 12: 340–348
Faaborg-Andersen K, Jensen M (1963) Unilateral paralysis of the superior laryngeal nerve. Acta Otol 57: 155–159
Friedman M, LoSavio P, Ibrahim H (2002) Superior laryngeal nerve identification and preservation in thyroidectomy. Arch Otolaryngol Head Neck Surg 128: 296–303
Hurtado-Lopez LM, Zaldivar-Ramirez FR (2002) Risk of injury to the external branch of the superior laryngeal nerve in thyroidectomy. Laryngoscope 112: 626–629
Moran RE, Castro AF (1951) The superior laryngeal nerve in thyroid surgery. Ann Surg 134: 1018–1021
Paulsen FP, Rudert HH, Tillmann BN (1999) New insights into the pathomechanism of postintubation arytenoid subluxation. Anesthesiology 91: 659–666
Rieger A, Hass I, Gross M, Gramm HJ, Eyrich K 1996 Intubation trauma of the larynx: a literature review with special reference to arytenoid cartilage dislocation. Anasthesiol Intensivmed Notfallmed Schmerzther 31: 281–287
Sataloff RT, Bough ID Jr, Spiegel JR (1994) Arytenoid dislocation: diagnosis and treatment. Laryngoscope 104: 1353–1361
Schultz-Coulon HJ, Brase A (1978) Clinical and radiological manifestations of unilateral subluxation of the cricothyroid joint (author's translation). HNO 26: 68–72
Stack BC Jr, Ridley MB (1994) Arytenoid subluxation from blunt laryngeal trauma. Am J Otolaryngol 15: 68–73
Talmi YP, Wolf M, Bar-Ziv J, Nusem-Horowitz S, Kronenberg J (1996) Postintubation arytenoid subluxation. Ann Otol Rhinol Laryngol 105: 384–390
Teitelbaum BJ, Wenig BL (1995) Superior laryngeal nerve injury from thyroid surgery. Head Neck 17: 36–40
Zeitels SM, Hillman RE, Desloge RB, Bunting GA (1999) Cricothyroid subluxation: a new innovation for enhancing the voice with laryngoplastic phonosurgery. Ann Otol Rhinol Laryngol 108: 1126–1131
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Schroeder, U., Motzko, M., Wittekindt, C. et al. Hoarseness after laryngeal blunt trauma: a differential diagnosis between an injury to the external branch of the superior laryngeal nerve and an arytenoid subluxation. A case report and literature review. Eur Arch Otorhinolaryngol 260, 304–307 (2003). https://doi.org/10.1007/s00405-002-0572-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00405-002-0572-9