Arytenoid cartilage necrosis due to prolonged endotracheal intubation: A case report of conservative follow-up with variable endoscopic findings

Abstract

AbstractArytenoid cartilage necrosis (ACN) is a life-threatening laryngeal complication that develops after prolonged endotracheal intubation (PEI). We describe a case of ACN due to PEI that was treated conservatively with close endoscopic follow-up. A 46-year-old man required 4 days of postoperative endotracheal intubation after surgery for Stanford A acute aortic dissection. Five days post-extubation, he presented with hoarseness and wheezing. Endoscopy and computed tomography findings confirmed ACN. We used conservative treatment to avoid a tracheostomy because the patient had no dyspnoea. During healing, vocal cord mobility changed per the extent of cicatrisation and adhesion, and glottic closure due to inter arytenoid adhesion was possible. The bilateral vocal cords were eventually fixed in a paramedian position. The patient could phonate via ventricular band mobility without aspiration or dyspnoea. Given the possibility of variable laryngeal findings, careful endoscopic evaluations may be needed until wound healing completes to avoid sudden suffocation after PEI.

Keywords

• Arytenoid cartilage necrosis
• prolonged endotracheal intubation
• laryngeal injury
• vocal cord mobility