The Laryngoscope

V
C 2010 The American Laryngological,
Rhinological and Otological Society, Inc.

Contemporary Review

Arytenoid Dislocation: An Analysis of the Contemporary Literature

Byron K. Norris, MD; John M. Schweinfurth, MD

Objectives/Hypothesis: To discuss the incidence, diagnosis, laryngeal findings, and management of arytenoid disloca-
tion as a separate entity from vocal fold paralysis.
Study Design: Literature review.
Methods: A contemporary review of the literature was performed by searching the terms arytenoid cartilage dislocation
and subluxation in various combinations. Articles were analyzed and selected based on relevance and content.
Results: Arytenoid dislocation is described as an uncommon laryngeal finding associated with intubation or blunt laryn-
geal trauma. The majority of recent publications are case reports or small case series. Diagnosis of arytenoid dislocation with
flexible laryngoscopy, helical computed tomography, videostroboscopy, and laryngeal electromyography is recommended. In
most reported cases, diagnosis has been made based on the position of the arytenoid at laryngoscopy. Reduction and reposi-
tioning of the arytenoid cartilage is reported with limited success noted with delayed diagnosis. Speech therapy may also be
a beneficial treatment option.
Conclusions: Although arytenoid dislocation is reported in the literature, the body of available evidence fails to suffi-
ciently differentiate it as a separate entity from unilateral vocal fold paralysis. Flexible laryngoscopy is inadequate as a stand-
alone procedure to distinguish arytenoid dislocation from laryngeal nerve injury.
Key Words: Arytenoid dislocation, arytenoid subluxation, vocal fold paralysis.
Level of Evidence: 5
Laryngoscope, 121:142–146, 2011

INTRODUCTION Early diagnosis of arytenoid dislocation is impor-

Arytenoid dislocation is a rare clinical entity. Com-
mon presenting symptoms include hoarseness, breathy
voice, and dysphagia. The overall incidence of arytenoid
dislocation is unknown, but it is reported to occur in
0.1% of tracheal intubations.1 The etiology is most com-
monly intubation, direct laryngoscopy, or blunt laryngeal
trauma, but it has been reported to be caused by
laryngeal mask airway use and esophageal probe place-
ment.2,3 The cricoarytenoid joint is a synovial-lined,
diarthrodial joint that may be prone to dislocation or
subluxation.4 Dislocation of the joint refers to complete
separation of the cartilaginous surfaces, whereas sub-
luxation is a partial dislocation that maintains some
contact between the joint surfaces.5 Although there is a
defined difference between dislocation and subluxation,
these joint injuries represent similar clinical entities,
and the terms are used interchangeably throughout this
manuscript.
From the Department of Otolaryngology and Communicative
Sciences, University of Mississippi, Jackson, Mississippi, U.S.A.
Editor’s Note: This Manuscript was accepted for publication
August 11, 2010.
The authors have no financial disclosures, conflicts of interest,
grants, or technical support to report.
Send correspondence to Byron K. Norris, MD, Resident, Depart-
ment of Otolaryngology and Communicative Sciences, University of Mis-
sissippi, 2500 North State Street, Jackson, Mississippi 39216.
E-mail: bnorris@umc.edu
DOI: 10.1002/lary.21276
tant.6–9 Diagnosis is performed through a combination of
laryngoscopy, videostroboscopy, computed tomography
(CT), and electromyography (EMG). Laryngoscopy and
stroboscopy in patients with suspected arytenoid joint
injury may display either an anteromedial or posterolat-
eral arytenoid position with reduced vocal fold motion.4
These laryngoscopic findings are similar to laryngeal
nerve injury, which will show decreased vocal fold activ-
ity and may show malposition of the arytenoid cartilage
owing to lack of muscular innervation. The purpose of
this report was to discuss the diagnosis and manage-
ment of arytenoid dislocation with a focus on
differentiating it as a separate entity from vocal fold
paralysis.
MATERIALS AND METHODS
PubMed and MEDLINE searches were conducted of the
English literature from the past 15 years by using the terms
arytenoid cartilage dislocation and subluxation. Also, reference
bibliographies were examined for additional articles. Abstracts
were reviewed for relevance and content related to the topic.
The review focused on literature associated with acute trau-
matic arytenoid dislocation referring to causation by direct
harm either through laryngoscopy, intubation, or blunt trauma.
Articles related to nontraumatic causes of cartilaginous disloca-
tion, such as rheumatoid arthritis or cancer, were excluded.
Cadaveric studies were also used; however, animal studies were
excluded. Articles were reviewed to elucidate criteria for diagno-
sis, treatment type, and response to treatment.

Laryngoscope 121: January 2011 Norris and Schweinfurth: Arytenoid Dislocation

142
 TABLE I.
Arytenoid Dislocation Case Report Summary
Case No. Year Published Authors Diagnosis Treatment Improvement

1 2009 Tan and Seevanayagam FFL ST Spontaneous

2 2008 Senoglu et al. FFL Closed reduction Delayed
3 2007 Niwa et al. FFL, CT Closed reduction Delayed
4 2007 Ysunza et al.* FFL, CT, EMG Closed reduction Immediate
5 2006 Mikuni et al. FFL None Spontaneous
6 2006 Dhanasekar et al. FFL, CT, Strobe Attempted closed reduction, ST Delayed
7 2004 Kennedy et al. CT, Strobe None No improvement
8 2003 Dillon et al. FFL, CT Closed reduction No improvement
9 2003 Dillon et al. FFL, CT Closed reduction Delayed
10 2003 Saigusa et al. FFL, Strobe, EMG Closed reduction NR
11 2001 Usui et al. FFL None Spontaneous
12 1999 Brosch and Johannsen FFL Attempted closed reduction No improvement
13 1999 Sataloff et al.† Strobe, CT, EMG Closed reduction Immediate
14 1998 Sataloff et al. FFL, Strobe Closed reduction Immediate
15 1997 Cros et al. FFL, EMG ST Delayed
16 1996 Hiong et al. Indirect, DL Attempted closed reduction, ST Delayed
17 1996 Rosenberg et al. FFL Closed reduction, botulinum Delayed
18 1996 Yin et al. Strobe, EMG NR NR
19 1996 Yin et al. Strobe, EMG NR NR
20 1996 Faries and Martella FFL, CT Closed reduction Delayed
21 1995 Sataloff et al. FFL, CT, EMG Attempted closed reduction‡ Immediate
*Complete data for only one patient.
†
Bilateral dislocation.
‡
Formal treatment with open arytenoid adduction–rotation.
FFL ¼ flexible fiberoptic laryngoscopy; ST ¼ speech therapy; CT ¼ computed tomography; EMG ¼ electromyography; Strobe ¼ videostroboscopy;
DL ¼ direct laryngoscopy; NR ¼ not recorded.

RESULTS through direct or indirect laryngoscopy, speech therapy,

Forty-three English literature articles were identi-
fied from the PubMed and MEDLINE searches and from
review of the relevant article bibliographies. Of these,
nine articles were excluded based on lack of relevant
content or were not applicable to the current review.
Case reports accounted for 21 patients in 19 articles
(Table I), with two articles reporting an additional
case.2,3,9–25 Case series (Table II) accounted for five
articles that represented 82 patients.1,4,5,26,27 In total,
the articles reported on 103 patients with 104 arytenoid
dislocations, as one patient experienced bilateral disloca-
tions.20 Thirty-nine percent of patients were reported by
a single author or the author’s associated group.4,20,21,25
The remainder of the articles, 23%, represented cadav-
eric studies, tutorials, or expert reviews.7,28–35
The diagnosis, treatment type, and outcomes for
reported cases of arytenoid dislocation are listed in
Tables I and II. Method of diagnosis, including videostro-
boscopy, EMG, and CT, is given (if reported). After
visualization of the arytenoid position by flexible endos-
copy, authors reported that stroboscopy was used in 69%
of patients to supplement the diagnosis. Patients
described in case series were more likely to have under-
gone video stroboscopy (85%) than those described in
case reports (33%). CT and EMG were used to confirm
the diagnosis in 56% and 42% of patients, respectively.
Treatment type reported varied between closed reduction
or spontaneous resolution. Closed reduction with reposi-
tioning of the arytenoid was the most common
treatment type, being used in 75% of patients. Of those
who underwent closed reduction, only 58% of patients
were reported to have had an immediate improvement.
Speech therapy was infrequently used, being reported in
only 14% of patients. Spontaneous resolution of symp-
toms was reported in four patients.10,13,18,26
DISCUSSION
Arytenoid dislocation was first reported in 1973 and
is a rare clinical entity.2 Dislocation of the arytenoid car-
tilage is generally an acute issue related to a direct
laryngeal event such as intubation, direct laryngoscopy,
or blunt external trauma. It is speculated that condi-
tions such as laryngomalacia, acromegaly, or chronic
steroid use may increase the risk of arytenoid dislocation
by weakening the joint capsule.33 Also, incidental find-
ings on CT of arytenoid malposition have been reported
with rheumatoid arthritis, laryngeal cancer, or chondror-
adionecrosis from radiation therapy.36,37 For the sake of
clarity and simplicity, we will focus only on arytenoid
dislocation or subluxation related to an acute event in
this report.
The arytenoid cartilage articulates with the cricoid
through a synovial-lined diarthroidial joint.33 It is

Laryngoscope 121: January 2011 Norris and Schweinfurth: Arytenoid Dislocation

143
 TABLE II.
Arytenoid Dislocation Case Series Summary
Year No. of
Case No. Published Authors Patients Strobe
1 2010 Hiramatsu et al. 12 NR
2 2009 Yamanaka et al. 3 100
3 2004 Rubin et al. 37* 100
4 2002 Wang and Liu 23 NR
5 1996 Talmi et al. 7 0
*Previously unreported patients.
EMG ¼ electromyography; CT ¼ computed tomography; NR ¼ not recorded.
postulated that the anatomy of the cricoarytenoid joint
provides stability to the arytenoid cartilage and resists
dislocation or subluxation.30,33 The pyramidal shape of
the arytenoid provides a wide base that allows extended
movement of the cartilage without losing contact with
the cricoid facet.38 In addition to a wide joint base, the
arytenoid cartilage is supported by the posterior crico-
arytenoid ligament and the intrinsic muscles of the
larynx.8 Although these anatomic features promote
arytenoid stability, the cricoarytenoid joint contains
large, well-vascularized, synovial folds.33 Trauma to
the arytenoid may cause hemarthroses of the joint
synovium leading to joint dysfunction and subsequent
subluxation.33
The pathogenesis of arytenoid subluxation is not
well understood, and it is theorized that intubation may
cause dislocation of the arytenoid joint through a variety
of mechanisms. Cadaveric studies have been performed
to investigate arytenoid biomechanics and have
attempted to replicate arytenoid dislocation.30,33,35
Attempted dislocation through intubation, extubation, or
manual manipulation was unsuccessful in all 37 of the
fresh cadaveric larynges studied by Paulsen et al.33
Wang’s analysis of seven fresh cadaveric larynges found
that considerable force was necessary to overcome struc-
tural supports and cause arytenoid dislocation.30 Based
on these cadaveric analyses, it is unlikely that the force
required for dislocation of the arytenoid joint is experi-
enced in most routine direct laryngoscopies or
intubations. In contrast, significant injury and force may
occur to the larynx during trauma.39 However, large
case series of patients with external laryngeal trauma
have not displayed cases of arytenoid dislocation with
the expected frequency of occurrence.39
Diagnosis
A thorough history and physical exam is indicated
for patients referred for suspected arytenoid dislocation.
The history should elucidate symptoms such as voice
changes, dysphagia, odynophagia, and any history of
external laryngeal trauma or recent intubation. A com-
plete otolaryngologic physical exam should be performed
with attention paid to the presence or absence of stridor,
dysphonia, and identifiable traumatic cervical lesions.
Fiberoptic laryngoscopy with the patient breathing and
phonating is essential to diagnosis. However, diagnosis
Laryngoscope 121: January 2011
144
Percentage of Patients
Closed Speech Immediate
EMG CT Reduction Therapy Improvement
33 100 25 NR 0
0 0 100 NR 100
86 59 89 1 73
0 43 100 NR 52
0 71 0 29 0
of arytenoid dislocation is difficult by fiberoptic laryngos-
copy alone.26 Videostroboscopy, laryngeal EMG, helical
CT scanning, and, occasionally, direct microlaryngoscopy
with palpation of the cricoarytenoid joint are reported to
be needed for confirmation.26 There is no gold standard
for diagnosis; however, arytenoid dislocation should be
considered as a diagnosis of exclusion after other condi-
tions including laryngeal nerve injury have been
successfully ruled out by using the previously listed
diagnostic aids.8 Arytenoid dislocation is thought to be
confirmed in patients who experience immediate
improvement in laryngeal symptoms such as hoarseness
after arytenoid repositioning.
With vocal fold paralysis, the arytenoid may appear
to be displaced anteromedially owing to lack of tone
in the ipsilateral posterior cricoarytenoid muscle.40
Schroeder et al. reported a case of suspected arytenoid
dislocation in a 36-year-old patient who experienced
blunt laryngeal trauma.41 Although the clinical picture
and laryngoscopic findings of anteromedial displacement
of the arytenoid suggested cricoarytenoid joint injury, la-
ryngeal EMG confirmed paralysis of the external branch
of the superior laryngeal nerve.41 Furthermore, when
reports published by Sataloff were excluded, only 14% of
patients underwent EMG and only 29% of patients were
diagnosed by using videostroboscopy. This evidence leads
further credence to the possibility of misdiagnosis in
patients with suspected arytenoid dislocation.
Laryngoscopy and Videostroboscopy
If cricoarytenoid dysfunction is suspected, visualiza-
tion of the larynx is imperative. Flexible fiberoptic
laryngoscopy has largely replaced indirect laryngoscopy
when detailed imaging is needed for diagnosis. Laryn-
goscopy should focus on the movement and position of
the vocal fold, position of the arytenoid cartilage, height
disparity between the vocal folds, and any signs of laryn-
geal trauma. Sataloff et al. describe the characteristic
laryngoscopy findings used to discriminate arytenoid dis-
location from vocal fold paralysis as including ‘‘absence
of a jostle sign…absence of increase in length with
increased pitch, and asymmetric vertical position of the
vocal process.’’6 The jostle sign is a laryngoscopic finding
indicative of unilateral vocal fold paralysis, and it
describes passive arytenoid movement on the affected
side during adduction.4,6 The jostle sign occurs because
Norris and Schweinfurth: Arytenoid Dislocation
of the bilateral innervation of the interarytenoid muscu-
lature and, therefore, partial medialization of the affected
arytenoid during adduction.6
Cases reported in the literature often used video-
stroboscopy for diagnostic confirmation of arytenoid
dislocation. Compared to flexible laryngoscopy, videostro-
boscopy can better help detect subtle movements of the
arytenoid and vocal fold.6 Key findings of arytenoid dis-
location, length of the vocal fold and height of the vocal
process, are better visualized through videostrobo-
scopy.4,8 Despite its utility, videostroboscopy was only
used for diagnosis in 33% of patients in case reports
compared to 85% of patients in case series. Without stro-
boscopy as an adjunct to diagnosis, the differential of
laryngeal nerve paresis or paralysis is not well excluded.
CT
If arytenoid dislocation is suspected from clinical his-
tory and laryngoscopy, further workup with laryngeal
imaging is reported to be helpful.28 CT is reported to dem-
onstrate changes to the cricoarytenoid joint such as
‘‘clouding or obliteration.’’7 If CT is used, then helical or
three-dimensional CT is recommended because of its
reduced imaging time and it’s high-resolution, multiplanar
results as compared with standard, nonhelical scans.26,28
Although CT is useful in identifying incorrect posi-
tion of the arytenoid cartilage, CT is unlikely to help
identify causative factors related to etiology of the malpo-
sitioned cartilage. Also, CT may not be able to help
differentiate arytenoid dislocation from unilateral vocal
fold paralysis, because both disorders display asymmetry
of the arytenoid cartilage.26 CT also may not be able to
help identify subtle changes in arytenoid position owing to
image slice thickness or patient movement. In a study by
Alexander et al., helical CT was unable to identify aryte-
noid asymmetry in 18% of patients where abnormalities of
the cricoarytenoid joint were seen on laryngoscopy.28
Laryngeal EMG
Laryngeal EMG is essential in distinguishing aryte-
noid dislocation from vocal fold paralysis.26,34 The
pattern of EMG most commonly identified in arytenoid
dislocation is one of normal recruitment.23 However,
other less common EMG patterns such as myopathy or
reinnervation may be identified.23 Findings on EMG
such as fibrillation potential or absence of electrical
activity are most likely associated with recurrent laryn-
geal nerve paralysis. Concomitant vocal fold paresis and
arytenoid dislocation have been reported in patients
where palpation of the arytenoid was necessary to con-
firm both diagnoses.6,25 However, if EMG suggests
neural denervation in the setting of malpositioned aryte-
noid cartilage by laryngoscopy or CT, then the cause of
the malposition is likely related to loss of muscular sta-
bility of the arytenoid cartilage and not joint dislocation.
Laryngeal EMG is also useful in diagnosing supe-
rior laryngeal nerve paralysis and distinguishing it from
arytenoid dislocation. Paralysis of the external branch of
the superior laryngeal nerve, which supplies motor
Laryngoscope 121: January 2011
innervation to the cricothyroid muscle, may display lar-
yngoscopy findings similar to arytenoid subluxation.
Similarities in laryngoscopy findings for both paralysis
of the superior laryngeal nerve and arytenoid dislocation
include a relaxed vocal fold, asymmetric arytenoid posi-
tion, and glottic chink.41 However, these entities may be
distinguished through laryngeal EMG, which will dis-
play absence of electrical activity with neural paralysis.
Despite its utility in assisting with diagnosis, laryn-
geal EMG was only used in 42% of reported patients
with suspected arytenoid dislocation. In addition, exclud-
ing reports published by Sataloff, only 14% of patients
described in either case series or case reports underwent
EMG for confirmatory testing. Without knowledge that
the neural pathway is intact or physical palpation of the
arytenoid cartilage, diagnosis of arytenoid dislocation is
inconclusive.
Treatment
Direct microlaryngoscopy with arytenoid reduction
and repositioning should be considered for treatment
when the diagnosis of dislocation has been confirmed.
Prompt diagnosis of arytenoid dislocation is recom-
mended before development of joint ankylosis hinders
successful arytenoid reduction.6–9 Arytenoid reduction
may be performed by using either general anesthesia or
local anesthesia and sedation, with the latter method
providing the benefit of being able to assess voice quality
intraoperatively.6 Sataloff et al. reports that after expo-
sure of the larynx, ‘‘considerable force is usually
required to reposition the cartilage,’’ and fracturing the
vocal process should be avoided.6 Efforts should be
focused on restoring the height of the vocal process.4
The use of botulinum toxin has been reported as a useful
adjunct to manual arytenoid reduction.29,31 Rontal and
Rontal reported 10 cases of anteromedial arytenoid dislo-
cation in which botulinum toxin was injected into the
interarytenoid muscles to chemically ‘‘splint’’ and restore
balance to the larynx.31 Although the theory of restoring
laryngeal balance through temporary chemical paralysis
seems valid, there is limited evidence to support its use
over manual reduction alone.
The majority of reported cases of arytenoid dis-
location (75%) were treated with closed reduction, and
58% of these patients were reported to have shown
an immediate improvement in symptoms. Immediate
improvement in symptoms supports the diagnosis of ary-
tenoid dislocation over laryngeal nerve injury, as neural
function may take months to return. However, only 21%
of patients discussed in case reports displayed immedi-
ate improvement, and most authors reported delayed or
no improvement after closed reduction. The finding of
delayed improvement may support an initial diagnosis of
laryngeal nerve injury that regains function over time.
One possible explanation for improvement after direct
laryngoscopy is the transient vocal swelling due to intu-
bation. This effect may temporarily improve glottic
closure and therefore voice.
Voice therapy has been reported as a useful adjunct
to treatment of arytenoid dislocation. Although only
used in 14% of recent reports, speech therapy has shown
Norris and Schweinfurth: Arytenoid Dislocation
145
good, albeit delayed, improvement in vocal function and
laryngeal symptoms. Reported voice therapy techniques
include simple vocal exercises, laryngeal relaxation tech-
niques, and instruction of proper compensatory
mechanisms.4,10,14 Although the mechanism of action of
speech therapy on arytenoid dislocation is unknown,
speech therapy exists as a viable alternative for patients
who do not receive improvement with arytenoid reduc-
tion or in whom reduction is not possible. Finally,
spontaneous improvement, although uncommon, has
been reported.10,13,18,26 It is postulated that the mecha-
nism of spontaneous recovery stems from internal
laryngeal forces due to coughing or vomiting; however,
surgical intervention should not be delayed in anticipa-
tion of spontaneous recovery.6
Successful treatment of arytenoid dislocation should
be considered as proper reduction of the arytenoid carti-
lage and return of laryngeal function.8 However, many
authors rely on improvements in voice quality and
symptoms, rather than correct arytenoid position, as the
basis for successful therapy.3,10,11,14,18,22 Only 37% of
case reports describe the performance of posttreatment
endoscopy2,15,16,19,21,24 or indirect laryngoscopy.9 Fur-
thermore, of these cases, the majority commented only
on vocal fold mobility and not on arytenoid position.
Posttreatment evaluation should include diagnostic aids
such as videostroboscopy and laryngeal EMG to further
confirm the diagnosis of arytenoid dislocation.
CONCLUSION
Arytenoid dislocation is a rare clinical finding usu-
ally associated with intubation or blunt laryngeal
trauma. Diagnosis of arytenoid dislocation is performed
through a combination of flexible endoscopy, videostrobo-
scopy, laryngeal EMG, CT, and occasionally manual
palpation of the arytenoid joint. Closed reduction of the
arytenoid cartilage is the hallmark of treatment, with
reported success rates in the majority of patients. Some
authors speculate that the incidence of arytenoid disloca-
tion may be underestimated and it may be frequently
misdiagnosed as vocal fold paralysis.1,6,30 However,
because the clinical picture and laryngoscopy findings
for the two entities are similar, laryngeal EMG is essen-
tial in distinguishing the two entities. Although the
incidence of arytenoid dislocation as a clinical entity
remains elusive, the diagnosis in many reported cases
may be questioned based on inadequate diagnostic data.
BIBLIOGRAPHY
1. Yamanaka H, Hayashi Y, Watanabe Y, Uematu H, Mashimo T. Prolonged
hoarseness and arytenoid cartilage dislocation after tracheal intubation.
Br J Anaesth 2009;103:452–455.
2. Niwa Y, Nakae A, Ogawa M, et al. Arytenoid dislocation after cardiac
surgery. Acta Anaesthesiol Scand 2007;51:1397–1400.
3. Rosenberg MK, Rontal E, Rontal M, Lebenbom-Mansour M. Arytenoid
cartilage dislocation caused by a laryngeal mask airway treated with
chemical splinting. Anesth Analg 1996;83:1335–1336.
4. Rubin AD, Hawkshaw MJ, Moyer CA, Dean CM, Sataloff RT. Arytenoid
cartilage dislocation: a 20-year experience. J Voice 2005;19:687–701.
5. Talmi YP, Wolf M, Bar-Ziv J, Nusem-Horowitz S, Kronenberg J. Postintu-
bation arytenoid subluxation. Ann Otol Rhinol Laryngol 1996;105:
384–390.
6. Sataloff RT, Bough ID Jr, Spiegel JR. Arytenoid dislocation: diagnosis and
treatment. Laryngoscope 1994;104:1353–1361.
Laryngoscope 121: January 2011
146
7. Rubin AD, Sataloff RT. Vocal fold paresis and paralysis. Otolaryngol Clin
North Am 2007;40:1109–1131, viii–ix.
8. Sataloff, RT. Arytenoid dislocation: techniques of surgical reduction. Oper
Tech Otolaryngol Head Neck Surg 1998;9:196–202.
9. Hiong YT, Fung CF, Sudhaman DA. Arytenoid subluxation: implications
for the anaesthetist. Anaesth Intensive Care 1996;24:609–610.
10. Tan V, Seevanayagam S. Arytenoid subluxation after a difficult intubation
treated successfully with voice therapy. Anaesth Intensive Care 2009;37:
843–846.
11. Senoglu N, Oksuz H, Ugur N, Dogan Z, Kahraman A. Arytenoid disloca-
tion related to an uneventful endotracheal intubation: a case report.
Cases J 2008;1:251.
12. Ysunza A, Landeros L, Pamplona MC, Prado H, Arrieta J, Fajardo G. The
role of laryngeal electromyography in the diagnosis of vocal fold immo-
bility in children. Int J Pediatr Otorhinolaryngol 2007;71:949–958.
13. Mikuni I, Suzuki A, Takahata O, Fujita S, Otomo S, Iwasaki H. Arytenoid
cartilage dislocation caused by a double-lumen endobronchial tube. Br J
Anaesth 2006;96:136–138.
14. Dhanasekar G, Sadri M, Mohan S, Young K, Leiberman J. Blunt laryngeal
trauma resulting in arytenoid dislocation and dysphonia. Auris Nasus
Larynx 2006;33:75–78.
15. Kennedy TL, Gilroy PA, Millman B, Greene JS, Pellitteri PK, Harlor M.
Strobovideolaryngoscopy in the management of acute laryngeal trauma.
J Voice 2004;18:130–137.
16. Dillon JP, Gallagher R, Smyth D. Arytenoid subluxation. Ir J Med Sci
2003;172:206.
17. Saigusa H, Kokawa T, Aino I, Iwasaki C, Nakamura T, Yagi T. Arytenoid
dislocation: a new diagnostic and treatment approach. J Nippon Med
Sch 2003;70:382–383.
18. Usui T, Saito S, Goto F. Arytenoid dislocation while using a McCoy laryn-
goscope. Anesth Analg 2001;92:1347–1348.
19. Brosch S, Johannsen HS. Clinical course of acute laryngeal trauma and
associated effects on phonation. J Laryngol Otol 1999;113:58–61.
20. Sataloff RT, Hawkshaw MJ, Spiegel JR. Complex bilateral arytenoid dislo-
cation. Ear Nose Throat J 1999;78:230–232.
21. Sataloff RT, McCarter AA, Hawkshaw M. Posterior arytenoid dislocation.
Ear Nose Throat J 1998;77:12.
22. Cros AM, Pitti R, Conil C, Giraud D, Verhulst J. Severe dysphonia after
use of a laryngeal mask airway. Anesthesiology 1997;86:498–500.
23. Yin SS, Qiu WW, Stucker FJ. Value of electromyography in differential di-
agnosis of laryngeal joint injuries after intubation. Ann Otol Rhinol Lar-
yngol 1996;105:446–451.
24. Faries PL, Martella AT. Arytenoid dislocation. Otolaryngol Head Neck
Surg 1996;115:160–162.
25. Sataloff RT, Spiegel JR, Heuer RJ, Hawkshaw MJ. Pediatric anterior ary-
tenoid dislocation. Ear Nose Throat J 1995;74:454–456.
26. Hiramatsu H, Tokashiki R, Kitamura M, Motohashi R, Tsukahara K,
Suzuki M. New approach to diagnose arytenoid dislocation and subluxa-
tion using three-dimensional computed tomography. Eur Arch Otorhino-
laryngol. June 12, 2010.
27. Wang Z, Liu Q. A comparative study on the close reduction of arytenoid
dislocation under indirect and direct laryngoscope. J Huazhong Univ
Sci Technolog Med Sci 2002;22:375–377.
28. Alexander AE Jr, Lyons GD, Fazekas-May MA, et al. Utility of helical
computed tomography in the study of arytenoid dislocation and aryte-
noid subluxation. Ann Otol Rhinol Laryngol 1997;106:1020–1023.
29. Rontal E, Rontal M. Laryngeal rebalancing for the treatment of arytenoid
dislocation. J Voice 1998;12:383–388.
30. Wang RC. Three-dimensional analysis of cricoarytenoid joint motion.
Laryngoscope 1998;108:1–17.
31. Rontal E, Rontal M. Botulinum toxin as an adjunct for the treatment of
acute anteromedial arytenoid dislocation. Laryngoscope 1999;109:164–166.
32. Maragos NE. Arytenoid fixation surgery for the treatment of arytenoid
fractures and dislocations. Laryngoscope 1999;109:834–837.
33. Paulsen FP, Rudert HH, Tillmann BN. New insights into the pathome-
chanism of postintubation arytenoid subluxation. Anesthesiology 1999;
91:659–666.
34. Munin MC, Murry T, Rosen CA. Laryngeal electromyography: diagnostic
and prognostic applications. Otolaryngol Clin North Am 2000;33:759–770.
35. Berry DA, Montequin DW, Chan RW, Titze IR, Hoffman HT. An investiga-
tion of cricoarytenoid joint mechanics using simulated muscle forces.
J Voice 2003;17:47–62.
36. Bayar N, Kara SA, Keles  I, Koc C, Altinok D, Orkun S. Cricoarytenoiditis
in rheumatoid arthritis: radiologic and clinical study. J Otolaryngol
2003;32:373–378.
37. Hermans R, Pameijer FA, Mancuso AA, Parsons JT, Mendenhall WM. CT
findings in chondroradionecrosis of the larynx. AJNR Am J Neuroradiol
1998;19:711–718.
38. Reidenbach MM, Schmidt H. Anatomic considerations on arytenoid carti-
lage dislocation. Clin Anat 1994;7:324–330.
39. Schaefer, S. The acute management of external laryngeal trauma: a 27-
year experience. Arch Otolaryngol Head Neck Surg 1992;118:598–604.
40. Hong KH, Jung KS. Arytenoid appearance and vertical level difference
between the paralyzed and innervated vocal cords. Laryngoscope 2001;
111:227–232.
41. Schroeder U, Motzko M, Wittekindt C, Eckel HE. 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 2003;260:304–307.
Norris and Schweinfurth: Arytenoid Dislocation