title: [Prolonged hoarseness and arytenoid dislocation after endotracheal intubation].
abstract: We present a case of prolonged hoarseness after tracheal intubation in a 62-year-old woman with bronchial asthma who underwent a pylorogastrectomy under a combination of epidural and general anesthesia. After the induction of anesthesia, the patient was carefully intubated using a 7.5-mm cuffed endotracheal tube without a stylet to avoid causing an asthma attack; the patient was extubated approximately 6 hours after the tracheal intubation. On the first postoperative day, the patient complained of hoarseness, vocal fatigue, and dysphagia. A direct laryngoscopy performed by an otorhinolaryngologist revealed dyskinesia of the left vocal cord and sufficient arytenoid cartilage mobility. The poor vocal fold mobility was probably caused by the force exerted on the left arytenoid by the convex curvature of the endotracheal tube, which had been inserted from the right side of the mouth, or a backward pressure on the thyroid cartilage during intubation. Early treatment is crucial in such cases, since the cricoarytenoid joint can become fibrosed in an unfavorable position. Fortunately, all the symptoms disappeared after one month in the present case. Although the trigger responsible for the spontaneous healing remains unknown, natural recovery might be associated with proper use of the vocal cords.
authors.affiliation: Department of Anesthesiology, Tokyo Women's Medical University Medical Center East, Tokyo 116-8567.
authors.forename: Junko
authors.initials: J
authors.lastname: Ichikawa
authors.forename: Mitsuharu
authors.initials: M
authors.lastname: Kodaka
authors.forename: Keiko
authors.initials: K
authors.lastname: Nishiyama
authors.forename: Miwako
authors.initials: M
authors.lastname: Kawamata
authors.forename: Makiko
authors.initials: M
authors.lastname: Komori
authors.forename: Makoto
authors.initials: M
authors.lastname: Ozaki
mesh_terms: D000767:Anesthesia, Epidural; D000768:Anesthesia, General; D001193:Arytenoid Cartilage; D001249:Asthma / Q000150:complications; D005260:Female; D005743:Gastrectomy; D006685:Hoarseness / Q000209:etiology*; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D004204:Joint Dislocations / Q000209:etiology*; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D013274:Stomach Neoplasms / Q000150:complications / Q000601:surgery; D014826:Vocal Cord Paralysis / Q000209:etiology