What is the role of laryngoscopy in the workup of cricoarytenoid (CA) fixation?

Updated: Jul 27, 2021
  • Author: Paul C Bryson, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

Operative direct laryngoscopy is the criterion standard for clinical evaluation of cricoarytenoid (CA) joint mobility.

  • The recommended technique requires that the patient be under general anesthesia with deep paralysis.

  • In the ideal situation, the patient is in laryngeal suspension, and the examiner uses 1 hand to externally stabilize the larynx while attempting endoscopic manipulation of the arytenoid.

  • This technique is intended to avoid misinterpreting movement of the entire larynx as arytenoid mobility.

  • Surrounding tissues, as well as the arytenoid, should be palpated to determine the presence of scarring or associated lesions.

  • Lateral displacement of 1 arytenoid accompanied by passive medial movement of the other may indicate interarytenoid tethering.

  • Careful attention to the exact placement of the laryngoscope is also important.

  • Placement of the blade too deeply in the laryngeal inlet may artificially restrict motion.

  • Note any associated subglottic stenosis and/or tracheal stenosis at the time of endoscopy.


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