Arytenoid Prolapse : Types, Causes, Symptoms, Treatment

There are various medical conditions that can lead to the prolapse of the airways. One such condition, in which the upper airway is obstructed, is known as Arytenoid prolapse. This condition is often preceded by laryngotracheoplasty.

The word prolapse means shifting of a part or organ from its actual position. Arytenoid prolapse is a medical condition wherein the arytenoid cartilage near the larynx shifts from its usual position causing airway obstruction. Arytenoid cartilage is a three-sided, small pyramid shaped structure on the larynx. The vocal chords are attached to the arytenoids which help in the movement of the vocal chords. It helps the vocal chords to relax, tense and approximated. At times, this arytenoid cartilage might shift from its position leading to arytenoid prolapse. The prolapse of the arytenoid cartilage might obstruct the airway giving rise to breathing difficulty.

Arytenoid prolapse is sub-classified into three types. These are –

• Type 1 or Antero-medial Arytenoid Prolapse: When the arytenoid cartilage collapses over the laryngeal inlet, it is categorized into this type.
• Type 2 or Antero-posterior Arytenoid Prolapse: In this type, the aryepiglottic folds become significantly and abnormally short. This reduces the antero-posterior dimension. Thus, the airway is obstructed.
• Type 3 Arytenoid Prolapse: During inspiratory aerodynamics, the laryngeal lumen is significantly narrowed down in this type of arytenoid prolapse. Therefore, an abnormal posterior deflection of the epiglottis takes place.

The symptoms of Arytenoid prolapse include:

• Hoarse Voice
• Vocal Fatigue
• Breathy voice quality
• Inability to voice out.

The less common symptoms of Arytenoid prolapse might include sore throat, cough, dysphagia, and odynophagia. The physical sign might include decreased vocal fold mobility, arytenoid edema along with arytenoid symmetry loss, poor closure of glottis, misalignment of the vocal fold and posterior glottis chink are some of the physical signs noted during diagnostic examinations.

Arytenoid prolapse is often reported to be occurring more in the children. Though it is quite a common occurrence or phenomenon that the upper airway will be obstructed more in children due to a general anaesthesia, why it leads to Arytenoid prolapse is not clear.

However, reports and research studies have shown that the paediatric patients are more susceptible to Arytenoid prolapse as they undergo halothane anaesthesia.

The doctors often consider the supraglottic tissue as responsible Arytenoid prolapse. The supraglottic tissues which are responsible for this condition are characteristically –

• Hypotense
• Floppy
• Hyperactive.

Apart from the supraglottic tissue, the conditions that are etiologically considered to be responsible for the Arytenoid prolapse are –

• Chronic use of inhaled steroids
• Vigorous exercise
• Neurodegenerative illnesses
• Asthmatic bronchospasms
• Cerebral vascular accident
• Traumatic brain injury
• Laryngeal trauma
• Connective tissue diseases
• Idiopathic laryngeal synkinesis.

However, none of these causes are considered to be the obvious causes in every case of Arytenoid prolapse.

Laryngotracheoplasty is a condition in which the subglottis is obstructed and the airway is blocked. In such a condition, Arytenoid prolapse is a possible outcome. Though the condition is quite difficult to identify, it usually requires surgical intervention to treat Arytenoid prolapse.

In case of severe laryngotracheal stenosis, especially the ones that occur in the children, a recent treatment method that is widely being used is CTR or Cricotracheal Resection. Reports have been received that this condition too can lead to arytenoid prolapse.

Those, who are suspected to be suffering from arytenoid prolapse, are diagnosed with a video endoscopy. This is considered to be an excellent tool that would clearly show the obstruction of the airway passage.

As this condition is diagnosed, the doctors provide a continuous and positive pressure of the airway. This has been proven to be an excellent way to clear the blocked airway and the obstruction is effectively removed.

Arytenoid prolapse is a rare condition with an incidence of 80 reported cases till date. The major factor contributing to arytenoid prolapse is laryngotracheoplasty or any laryngeal instrumentation. However, the condition needs a detailed evaluation and research so that the exact causes that lead to arytenoid prolapse can be diagnosed, treated and prevented.