What causes cricoarytenoid (CA) fixation?

Updated: Jul 27, 2021
  • Author: Paul C Bryson, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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After cricoarytenoid (CA) joint fixation is diagnosed, determining the etiology is of paramount importance for therapeutic decision making. Following are the 3 general categories of causes of cricoarytenoid (CA) fixation:

  1. Arthritides, primarily rheumatoid arthritis, account for many clinical diagnoses of cricoarytenoid (CA) fixation. Other known causes of joint arthritis include gout, Reiter syndrome, and ankylosing spondylitis. Anecdotal evidence suggests a mumps-associated laryngeal arthritis. This category also may include fixation secondary to radiation therapy.

  2. Direct bacterial involvement of the joint space with infectious agents, such as streptococcal species, with resultant ankylosis is recognized.

  3. Direct or external laryngeal trauma may result in joint injury. Mechanisms of intubation-related joint injury are suggested. These include posterior or anterior arytenoid displacement secondary to the distal tip of the endotracheal tube engaging the arytenoid during intubation. Some have noted the possibility of posterior dislocation resulting from extubation with a partially inflated endotracheal tube cuff. Another potential cause is arytenoid chondritis secondary to prolonged endotracheal intubation, which ultimately results in fibrosis. Zhong et al reported on a patient who experienced arytenoid dislocation following anterior cervical corpectomy and fusion. [1]

Previous authors have speculated that long-term paralysis with resultant cricoarytenoid (CA) immobility may lead to joint fixation, as observed in other diarthrodial joints in the body. However, histologic studies have failed to demonstrate this association.

A study by Tanaka et al reported that in transoral videolaryngoscopic surgery for hypopharyngeal and supraglottic cancer, resection of the medial and lateral pyriform sinus can lead to postoperative voice impairment; consequent to the operation, scar contracture around the cricoarytenoid joint can fix the arytenoid cartilage toward the lateral position and patients can experience insufficient glottic closure. [2]

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