Clinical characteristics of arytenoid dislocation in patients undergoing bariatric/metabolic surgery

Abstract

Tracheal intubation and the use of a large-bore calibrating orogastric (OG) tube have been reported to increase the incidence of arytenoid dislocation (AD) in patients undergoing bariatric/metabolic surgery. This study aimed at identifying the clinical characteristics of this patient subgroup. We retrospectively examined the clinical characteristics of 14 patients with AD (study group) who received tracheal intubation and OG insertion for bariatric/metabolic surgery between 2011 and 2016. For comparison, another group of 19 patients with postoperative AD collected from published literature and 3 patients from the authors’ institute served as controls in whom only tracheal intubation was performed. Information on patient characteristics, anesthetic time, symptoms, time of symptom onset, intervention, and postinterventional impact on vocalization of the 2 groups were collected and compared. Patients in the study group were younger than those in the control group (38 [25–60] vs 54.5 [19–88] years, P = .03). Compared with the control group, anesthetic time (282.5 [155–360] vs 225 [25–480] minutes, P = .041) was longer and symptom onset (1.0 [0–6] vs 1.0 [0–6] days, P = .018) was more delayed in the study group. After closed reduction, the frequency of voice recovery was comparable in both groups in a time interval of 12 weeks (84.6% vs 92.9%, P = .59). Our report demonstrates that the clinical characteristics of patients with AD who received tracheal intubation and OG insertion for bariatric/metabolic surgery were different from those with postoperative AD receiving only tracheal intubation, highlighting the importance of implementing individualized strategies for AD prevention in this patient population. Abbreviations: AD = arytenoid dislocation, CAJ = cricoarytenoid joint, GERD = gastroesophageal reflux disease, OG = calibrating orogastric, POD = postoperative day.