Clinical Note |

Cricoid Cartilage Necrosis After Arytenoidectomy in a Previously Irradiated Larynx

Georg Mathias Sprinzl, MD; Hans Edmund Eckel, MD; Stephan Ernst, MD; Kambiz Motamedi, MD
Arch Otolaryngol Head Neck Surg. 1999;125(10):1154-1157. doi:10.1001/archotol.125.10.1154.
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Several open and endoscopic surgical techniques are available to provide an adequate airway for patients with bilateral vocal cord paralysis. Transoral laser arytenoidectomy has repeatedly been reported to be a reliable and effective minimally invasive procedure for airway restoration. To our knowledge, there have been no previous reports of serious complications, other than poor vocal results, aspiration, and failed decannulation in individual patients, that have resulted from this intervention. We report a case in which arytenoidectomy led to severe complications and death. Prior irradiation is suspected to be a causative factor. To prevent such an outcome, we believe that operative settings should be chosen that avoid deep thermal injury of the laryngeal framework.

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Figure 1.

Lateral view of the patient demonstrating severe inflammation of the left neck region and necrosis of the skin. A deltopectoral flap (D) was raised 1 week earlier for the reconstruction of the cervical skin. Arrows indicate skin necrosis with visible calcified parapharyngeal mass.

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Figure 2.

An axial computed tomographic scan shows the inflammatory process with a defect in the anterior portion of the cricoid cartilage (arrow) and a paralaryngeal calcified mass (asterisk).

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Figure 3.

A horizontal section of the whole-organ plastinated larynx in the glottic plane. The left arytenoid cartilage was removed 4 months before the laryngectomy was performed. There are distinct adhesions located in the anterior commissure (arrow).

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Figure 4.

A horizontal section of the whole-organ plastinated larynx shows the defect in the lateral portion of the cricoid arch (arrow) and the paralaryngeal calcified mass (asterisk) on the left side.

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