Arytenoid prolapse: a source of obstruction following laryngotracheoplasty.
OBJECTIVE
Arytenoid prolapse is a potential source of upper airway obstruction following laryngotracheoplasty, and may be difficult to identify. We explored the incidence, clinical features, etiology, and surgical approach to patients with arytenoid prolapse following laryngotracheoplasty.


METHODS
Case series with chart review.


METHODS
The charts of 93 patients diagnosed with arytenoid prolapse following laryngotracheoplasty from 1981 to 2007 were reviewed.


RESULTS
The incidence was 5.7 percent (93/1634). Forty-nine patients had unilateral prolapse; 44 had bilateral prolapse. Average time from laryngotracheoplasty to presentation was 36.8 months. Common symptoms were dyspnea on exertion, tracheostomy dependence, and sleep-disordered breathing. Fifty-four patients (58%) required surgical intervention, with arytenoid reduction performed in 45 patients. Nine underwent reduction during revision laryngotracheoplasty or cricotracheal resection. Fourteen patients required a second procedure for persistent prolapse. Thirty-nine (42%) required no intervention. Symptom resolution or decannulation was achieved in all patients in whom prolapse was the source of obstruction. Statistically significant differences were found when anterior vs posterior graft utilization was compared.


CONCLUSIONS
Arytenoid prolapse is a cause of airway obstruction following laryngotracheoplasty. Subtle airway complaints and decannulation failures are common features. Both endoscopic and open procedures can successfully treat arytenoid prolapse. Potential etiologies are discussed.
Hart
Catherine K
CK
Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati Medical Center and Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Richter
Gresham T
GT
Cotton
Robin T
RT
Rutter
Michael J
MJ
D000402:Airway Obstruction / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D001193:Arytenoid Cartilage / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007830:Larynx / Q000601:surgery*; D008297:Male; D011391:Prolapse; D012086:Reoperation; D014132:Trachea / Q000601:surgery*; D016896:Treatment Outcome