Laryngeal intubation injuries refer to laryngeal damage caused by tracheal intubation and endotracheal tube cuffs, such as traumatic laryngeal granuloma, cricoarytenoid joint dislocation, laryngeal edema, and laryngeal mucosal injury. This section focuses on traumatic laryngeal granuloma and cricoarytenoid joint dislocation.
Traumatic Laryngeal Granuloma
Traumatic laryngeal granuloma caused by tracheal intubation was first reported in 1932. The underlying causes include mucosal injury during intubation, the use of an endotracheal tube with an excessively large diameter, or prolonged intubation. The resulting mucosal wounds may later develop granulomatous tissue due to exposure to gastric acid reflux material.
Granulomas commonly occur at the vocal process of the arytenoid cartilage. Most cases appear 2 to 8 weeks after extubation, with a higher incidence in female patients, likely due to the smaller size and thinner mucosa of the female larynx. Larger granulomas may cause hoarseness. Examination reveals granulomatous lesions at the junction of the middle and posterior thirds of the vocal cords.
Granulomas with stalks may be removed in laryngoscopy, but recurrence is common. Treatment targeting gastric acid reflux has shown favorable outcomes.
Cricoarytenoid Joint Dislocation
Cricoarytenoid joint dislocation can result from forceful or improper tracheal intubation techniques. Clinically, patients under general anesthesia may experience hoarseness or aphonia immediately after extubation. Some cases can also present with laryngeal pain and dysphagia.
Laryngoscopic examination shows that the arytenoid cartilage on the affected side remains fixed or exhibits limited movement during phonation. Mucosal swelling of varying degrees and incomplete glottic closure may also be observed. It is essential to differentiate between anterior and posterior dislocation of the arytenoid cartilage during evaluation.
Repositioning of the arytenoid cartilage should be performed as early as possible, with the method adjusted according to the type of dislocation.