Arytenoid prolapse is shifting of arytenoid cartilage from its normal position. This can lead to obstruction of air passage. Arytenoids are pair of triangular cartilages present in larynx. The vocal cords are attached to arytenoid cartilages. Arytenoid helps to move the vocal cords. It helps the vocal cord to become relaxed, tensed and approximated. Sometimes arytenoid cartilage can move from its normal anatomical position and this may give rise to arytenoid prolapse.
The prolapsed cartilage can obstruct airway causing difficulty in breathing. It can occur after laryngotracheoplasty surgery or may develop due to various other reasons such as asthma, paralysis, connective tissue disease etc.Besides breathing difficulty, patient may also suffer from other symptoms such as hoarseness, easy fatigue of voice while speaking, etc. Treatment consists of maintaining constant positive pressure in air passage.
There are three types of arytenoid prolapse. In type 1 the cartilage gets collapsed on inlet of larynx. In type 2, the epiglottic folds become short. This causes reduction in the size of arytenoid cartilage leading to obstruction in the air passage. In type 3, the lumen of larynx becomes narrow causing prolapsed of the arytenoid cartilage.
What Are The Causes Of Arytenoid Prolapse?
In majority of cases the reason for arytenoid cartilage prolapse is because of supraglottic tissue.When the supraglottic tissue becomes floppy, hypotensed or hyperactive there is risk of arytenoid prolapse. Aside from the supraglottic tissue, the other probable causes include:
- Bronchospasm in asthma attacks.
- Strenuous exercise.
- Use of steroids for many months or years.
- Neurological illness such as stroke.
- Brain injury due to accidents.
- Trauma to larynx during surgical procedure.
- Connective tissue disorders.
The causes mentioned above may not always be responsible for arytenoid prolapse.
Pathophysiology of arytenoid prolapse: The vocal cord that generates voice can move because they are attached to arytenoids cartilage. When the subglottis in the throat gets blocked it causes obstruction in the airway.This can cause prolapse of arytenoid cartilages. Laryngotracheal stenosis especially in children is commonly associated with arytenoid prolapse. The cartilage prolapse is often observed among children who undergo general anesthesia during surgery. Especially when halothen is used as an anesthetic medium.
Signs And Symptoms Of Arytenoid Prolapse
Following are the signs and symptoms commonly associated with arytenoid prolapse.
- Hoarseness of voice.
- Voice fatigue while speaking.
- Patient unable to speak.
- Breathing difficulty.
- Difficulty in swallowing, sometimes even causing pain in throat while swallowing.
- Sore throat
- When seen through the laryngoscope, the physical sign may indicate swelling of the arytenoids cartilage.
- The movement of vocal cord is reduced.
- The glottis does not close properly.
- Loss of symmetry in the shape of cartilage.
Diagnosis And Treatment Of Arytenoid Prolapse
Arytenoid prolapse is uncommon and rare medical condition. Very few people suffer from it. As mentioned earlier, it may be a consequence of a procedure called laryngotracheostomy. It may also develop during any instrumentation procedure carried out for larynx problems. If at all the doctor suspects arytenoid prolapse, he will use video endoscopsy as the most efficient diagnostic procedure. This procedure shows prolapse and obstruction caused by the arytenoid cartilage.
The most reliable and effective treatment for curing arytenoid prolapse is use of continuous positive air pressure on the airway. This helps to clear the blockage of airway as well as removes the prolapse.