Cricoarytenoid Arthritis

Etiology

Primary Rheumatologic Disease

Other

  • Cricoarytenoid Joint Ankylosis Due to Prior Streptococcus Infection
  • Crohn’s Disease (see Crohn’s Disease, [[Crohns Disease]])
  • Mumps-Associated Laryngeal Arthritis (see Mumps Virus, [[Mumps Virus]])
  • Radiation Therapy Injury to Cricoarytenoid Joint
  • External Trauma to Cricoarytenoid Joint
  • Internal Trauma Due to Endotracheal Tube-Related Injury to Cricoarytenoid Joint: includes posterior or anterior arytenoid displacement, posterior dislocation resulting from extubation with a partially inflated endotracheal tube cuff, arytenoid chondritis secondary to prolonged endotracheal intubation
  • Tietze’s Syndrome

Physiology

  • Cricoarytenoid Joint is a Diarthrodial Joint: includes a synovial lining and a fluid-filled bursa
    • The joint capsule and the ligamentous attachments, including the cricoarytenoid ligament, vocal ligament, and false vocal folds, limit normal motion of the joint
    • Motion of the arytenoid is characterized primarily as the arytenoid rocking over the long axis of the cricoid facet and gliding parallel to the long axis, as well as a small component of axial movement pivoting on the cricoarytenoid ligament
    • Three-dimensional analysis of cricoarytenoid mobility demonstrates that the arytenoid has rotates superiorly, posteriorly, and laterally in full abduction
  • Cricoarytenoid Fixation: abnormality of decreased joint mobility which results from trauma, injury, infection, or inflammation of joint

Diagnosis

  • Operative Direct Laryngoscopy: the standard for clinical evaluation of cricoarytenoid joint mobility

Clinical Manifestations

Pulmonary Manifestations

  • Dysphonia (see Dysphonia, [[Dysphonia]])
  • Aspiration Pneumonia (see Aspiration Pneumonia, [[Aspiration Pneumonia]])
  • Exertional Dyspnea (see Dyspnea, [[Dyspnea]])
  • Acute Upper Airway Obstruction (see Obstructive Lung Disease, [[Obstructive Lung Disease]])
    • Nocturnal or daytime stridor
  • Acute Respiratory Failure (see Acute Hypoventilation, , [[Acute Hypoventilation]]): due to high-grade upper airway obstruction with excessive work of breathing

Other Manifestations


Treatment

  • Treatment of Acute Cricoarytenoid Rheumatoid Arthritis: treat with anti-inflammatory and analgesic medications (with or without systemic steroids), adjunctive vocal rest, local heat, and humidification
    • Periarticular local steroid injections may help in ameliorating acute joint dysfunction
  • Treatment of Infectious Cricoarytenoid Arthritis: antibiotics
  • Surgery: may be required to restore mobility to cricoarytenoid joint

References

  • Wang R. Three-dimensional analysis of cricoarytenoid joint motion. Laryngoscope. 1998;4 Pt 2 supp 86:1-17
  • Schaefer SD, Close LG, Brown OE. Mobilization of the fixated arytenoid in the stenotic posterior laryngeal commissure. Laryngoscope. Jun 1986;96(6):656-9
  • Ejnell H, Bake B, Mansson I, et al. New mobilization and laterofixation procedure for cricoarytenoid joint ankylosis in rheumatoid arthritis. Ann Otol Rhinol Laryngol. Sep-Oct 1985;94(5 Pt 1):442-4
  • Cummings CW, Redd EE, Westra WH, Flint PW. Minimally invasive device to effect vocal fold lateralization. Ann Otol Rhinol Laryngol. Sep 1999;108(9):833-6
  • Rovo L, Venczel K, Torkos A, Majoros V, Sztano B, Jori J. Endoscopic arytenoid lateropexy for isolated posterior glottic stenosis. Laryngoscope. Sep 2008;118(9):1550-5
  • Kashima HK. Bilateral vocal fold motion impairment: pathophysiology and management by transverse cordotomy. Ann Otol Rhinol Laryngol. Sep 1991;100(9 Pt 1):717-21
  • Ossoff RH, Sisson GA, Duncavage JA, Moselle HI, Andrews PE, /McMillan WG. Endoscopic laser arytenoidectomy for the treatment of bilateral vocal cord paralysis. Laryngoscope. Oct 1984;94(10):1293-7
  • Benninger MS, Gillen JB, Altman JS. Changing etiology of vocal fold immobility. Laryngoscope. Sep 1998;108(9):1346-50
  • Bosley B, Rosen CA, Simpson CB, /McMullin BT, Gartner-Schmidt JL. Medial arytenoidectomy versus transverse cordotomy as a treatment for bilateral vocal fold paralysis. Ann Otol Rhinol Laryngol. Dec 2005;114(12):922-6
  • Bridger MW, Jahn AF, van Nostrand AW. Laryngeal rheumatoid arthritis. Laryngoscope. Feb 1980;90(2):296-303
  • Bryer D, Rounthwaite FJ. Cricoarytenoid arthritis due to mumps. Laryngoscope. Mar 1973;83(3):372-5
  • Colman MF, Schwartz I. The effect of vocal cord paralysis on the cricoarytenoid joint. Otolaryngol Head Neck Surg. May-Jun 1981;89(3 Pt 1):419-22
  • Elsherief S, Elsheikh MN. Endoscopic radiosurgical posterior transverse cordotomy for bilateral median vocal fold immobility. J Laryngol Otol. Mar 2004;118(3):202-6
  • Gacek M, Gacek RR. Cricoarytenoid joint mobility after chronic vocal cord paralysis. Laryngoscope. Dec 1996;106(12 Pt 1):1528-30
  • Goodman M, Montgomery W, Minette L. Pathologic findings in gouty cricoarytenoid arthritis. Arch Otolaryngol. Jan 1976;102(1):27-9
  • Jurik AG, Pedersen U, Noorgard A. Rheumatoid arthritis of the cricoarytenoid joints: a case of laryngeal obstruction due to acute and chronic joint changes. Laryngoscope. Jul 1985;95(7 Pt 1):846-8
  • Kasperbauer JL. A biomechanical study of the human cricoarytenoid joint. Laryngoscope. Nov 1998;108(11 Pt 1):1704-11
  • Maragos NE. Arytenoid fixation surgery for the treatment of arytenoid fractures and dislocations. Laryngoscope. May 1999;109(5):834-7
  • Sataloff RT, Bough ID Jr, Spiegel JR. Arytenoid dislocation: diagnosis and treatment. Laryngoscope. Nov 1994;104(11 Pt 1):1353-61
  • Simpson GT 2nd, Javaheri A, Janfaza P. Acute cricoarytenoid arthritis: local periarticular steroid injection. Ann Otol Rhinol Laryngol. Nov-Dec 1980;89(6 Pt 1):558-62