Cricoarytenoid Arthritis

Etiology

Primary Rheumatologic Disease

Ankylosing Spondylitis (see Ankylosing Spondylitis)
Gout (see Gout)
Reiter’s Syndrome (see Reiter’s Syndrome)
Rheumatoid Arthritis (RA) (see Rheumatoid Arthritis)
- Rheumatoid nodules may occur in soft tissues surrounding the cricoarytenoid joint
Systemic Lupus Erythematosus (SLE) (see Systemic Lupus Erythematosus)

Other

Cricoarytenoid Joint Ankylosis Due to Prior Streptococcus Infection
Crohn’s Disease (see Crohn’s Disease)
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
Mumps-Associated Laryngeal Arthritis (see Mumps Virus)
Radiation Therapy Injury to Cricoarytenoid Joint (see Radiation Therapy)
Tietze’s Syndrome

Physiology

Cricoarytenoid Joint is a Diarthrodial Joint

Cricoarytenoid 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

Acute Respiratory Failure (see Respiratory Failure)
- Physiology
  - Due to High-Grade Upper Airway Obstruction with Excessive Work of Breathing
Acute Upper Airway Obstruction (see Obstructive Lung Disease)
- Nocturnal or Daytime Stridor
Aspiration Pneumonia (see Aspiration Pneumonia)
Dysphonia (see Dysphonia)
Exertional Dyspnea (see Dyspnea)

Other Manifestations

Globus Sensation (see Globus Sensation)
Sore Throat/Pharyngitis (see Pharyngitis)
Otalgia (see Otalgia)
Dysphagia (see Dysphagia)
Odynophagia (see Odynophagia)

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

Three-dimensional analysis of cricoarytenoid joint motion. Laryngoscope. 1998;4 Pt 2 supp 86:1-17
Mobilization of the fixated arytenoid in the stenotic posterior laryngeal commissure. Laryngoscope. Jun 1986;96(6):656-9
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
Minimally invasive device to effect vocal fold lateralization. Ann Otol Rhinol Laryngol. Sep 1999;108(9):833-6
Endoscopic arytenoid lateropexy for isolated posterior glottic stenosis. Laryngoscope. Sep 2008;118(9):1550-5
Bilateral vocal fold motion impairment: pathophysiology and management by transverse cordotomy. Ann Otol Rhinol Laryngol. Sep 1991;100(9 Pt 1):717-21
Endoscopic laser arytenoidectomy for the treatment of bilateral vocal cord paralysis. Laryngoscope. Oct 1984;94(10):1293-7
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
Laryngeal rheumatoid arthritis. Laryngoscope. Feb 1980;90(2):296-303
Cricoarytenoid arthritis due to mumps. Laryngoscope. Mar 1973;83(3):372-5
The effect of vocal cord paralysis on the cricoarytenoid joint. Otolaryngol Head Neck Surg. May-Jun 1981;89(3 Pt 1):419-22
Endoscopic radiosurgical posterior transverse cordotomy for bilateral median vocal fold immobility. J Laryngol Otol. Mar 2004;118(3):202-6
Cricoarytenoid joint mobility after chronic vocal cord paralysis. Laryngoscope. Dec 1996;106(12 Pt 1):1528-30
Pathologic findings in gouty cricoarytenoid arthritis. Arch Otolaryngol. Jan 1976;102(1):27-9
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
A biomechanical study of the human cricoarytenoid joint. Laryngoscope. Nov 1998;108(11 Pt 1):1704-11
Arytenoid fixation surgery for the treatment of arytenoid fractures and dislocations. Laryngoscope. May 1999;109(5):834-7
Arytenoid dislocation: diagnosis and treatment. Laryngoscope. Nov 1994;104(11 Pt 1):1353-61
Acute cricoarytenoid arthritis: local periarticular steroid injection. Ann Otol Rhinol Laryngol. Nov-Dec 1980;89(6 Pt 1):558-62 [MEDLINE]