Clinical features of arytenoid dislocation after endotracheal intubation: a 3-year retrospective single-center study

Clinical features of arytenoid dislocation after endotracheal intubation: a 3-year retrospective single-center study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Clinical features of arytenoid dislocation after endotracheal intubation: a 3-year retrospective single-center study En-ci Liu, Guo-rong Wu, Cheng Kang, Jun-ping Chen, Wei Qi This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7072258/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Arytenoid dislocation (AD), a rare laryngeal injury that may follow endotracheal intubation, requires systematic characterization. We aimed to review the clinical features of AD after the endotracheal intubation and evaluate the treatment timing and vocal outcomes. Methods: We reviewed the medical records of patients who underwent operation under general anesthesia with endotracheal intubation from January 2022 to December 2024. Patient, anesthetic, and surgical factors associated with AD were analyzed. Results: A total of 29 patients with AD were identified. The patients had undergone the endotracheal intubation for abdominal surgery (n=19), video-assisted thoracoscopic surgery (n=4), head and neck surgery (n=3), and cardiac surgery (n=3). A total of 11 patients were intubated by the resident anesthetist and 18 patients by the staff anesthetist. An intraoperative nasogastric tube or transesophageal echocardiography probe was placed in 75.9% of patients. The operation time ranged between 105 and 626 minutes with a mean of 264.7 ± 126.0 minutes. The most common symptom was hoarseness (n=21), followed by dysphagia (n=7), odynophagia (n=3). Left-sided dislocation observed in 20 (67.0%) cases. Closed reduction was performed as first-line therapy in confirmed AD cases. The time from primary surgical intervention to closed reduction was 9.9 ± 10.5 days. Although there was no significant association between treatment timing and vocal recovery categories, closed reduction intervention within the critical 7-day window achieved the improved vocal outcomes (66.7%) higher than delayed intervention (37.5%). Conclusions: This study indicates that AD after the endotracheal intubation featured by prolonged surgical duration (>180 minutes), abdominal surgery, and concurrent nasogastric tube or transesophageal echocardiography probe placement. Even if there is no significant association between treatment timing and vocal recovery, we recommend earlier intervention. Arytenoid dislocation Endotracheal intubation Closed reduction Vocal recovery Treatment timing Background Arytenoid dislocation (AD), a rare laryngeal injury involving displacement of the arytenoid cartilage from the cricoarytenoid joint, disrupts vocal fold function and may cause hoarseness, dysphagia, or aspiration if untreated [1, 2] . Endotracheal intubation, a common airway intervention in anesthesia practice, poses a risk of AD via direct trauma or duration of intubation [3] , which is critical in anesthesia practice due to potential iatrogenic harm[4]. Previous reports suggest that the incidence of AD occurring in less than 0.1% of patients after general anesthesia [3, 5] . The current literature focuses on the risk factors of AD after endotracheal intubation [6, 7] , and treatment timing remain controversy [8, 9] . Therefore, clarifying the clinical features of AD after endotracheal intubation is crucial to guide timely treatment and improve patients’ satisfaction after anesthesia. In this article, our experiences of AD after endotracheal intubation in 29 cases are presented to emphasize the perioperative clinical characteristics, especially evaluating the treatment timing and vocal outcomes. Methods Ethical approval This study was reviewed and approved by the Institutional Review Board (IRB) of Ningbo No.2 Hospital (Approval Number: PJ-NBEY-KY-2025-104-01), with a waiver of informed consent due to its retrospective design. All procedures were conducted in accordance with the ethical standards of the Declaration of Helsinki and with relevant guidelines and regulations. Subjects This study was performed retrospectively from the perioperative period of patients who underwent endotracheal intubation had AD. Between January 2022 and December 2024, 29 patients had AD after the endotracheal intubation. These constituted 0.03% of the 101204 general anesthesia following endotracheal intubation procedures performed in this center during that period. Evaluation Patients presenting with hoarseness or pharyngeal discomfort after tracheal intubation under general anesthesia should be evaluated by an otolaryngology specialist. The clinical diagnosis of AD was investigated by the fiberoptic laryngoscopy, with computed tomography (CT) additionally performed in 6 cases for further assessment. Treatment Patients diagnosed with AD underwent closed reduction as the primary intervention. Therapeutic regimens were stratified into those receiving closed reduction alone, and reduction with aerosol inhalation therapy and/or voice therapy. If the patient can tolerate it, closed reduction is performed under local anesthesia, otherwise under general anesthesia. Post-reduction joint stability was systematically evaluated through endoscopic visualization and functional phonatory assessment by an otolaryngology specialist. Data collection Patient charts, operative reports, fiberoptic laryngoscopy examinations and CT scan reports were reviewed retrospectively for each participating patient. Charts were reviewed to obtain information about etiological factors of first surgery: the surgical category, anesthesiologist experience level, endotracheal tube size, intraoperative oropharyngeal tube placement status, and operative duration; the side of dislocation (left or right), duration between first operation and closed reduction, treatment and voice results. Voice results were initially determined subjectively by the patient and otolaryngology specialist. Outcomes were categorized as: 1) Normal - patient felt that his or her voice had returned to preinjury quality; 2) Improved - significant improvement in voice was achieved, although not to preinjury quality; 3) Mild improved - signify minimal improvement in voice quality; 4) Unchanged - no improvement in voice quality. Statistics Results were calculated and reported as the number (percentages) and mean (standard deviation). The Mann–Whitney test was used for continuous variables, and the Chi-square test was used for categorical variables. A P value less than 0.05 was considered statistically significant. Statistical analyses were performed using SPSS version 29.0 (SPSS Inc, Chicago, Illinois, USA). Results Table 1 summarizes the demographic characteristics, surgical details, endotracheal intubations, treatments, and vocal outcomes. The study group of 29 patients included 17 male patients (58.6%) and 12 female patients (41.4%). The age of the patients ranged between 29 and 89 years with a mean of 66.2 ± 12.7 years. The mean BMI was 23.06 ± 3.07. The patients had undergone the endotracheal intubation for abdominal surgery (n=19), video-assisted thoracoscopic surgery (n=4), head and neck surgery (n=3), and cardiac surgery (n=3). A total of 11 patients were intubated by the resident anesthetist and 18 patients by the staff anesthetist. All intubations were performed without technical difficulties. Of the intubations performed by resident anesthetists, first-year residents accounted for 45.4% (5/11), second-year residents for 18.2% (2/11), and third-year residents for 36.4% (4/11). An intraoperative nasogastric tube or transesophageal echocardiography probe was placed in 75.9% of patients. The operation time ranged between 105 and 626 minutes with a mean of 264.7 ± 126.0 minutes. The most common symptom was hoarseness (n=21), followed by dysphagia (n=7), odynophagia (n=3), decreased volume (n=2), vocal fatigue (n=1), loss of volume (n=1), and air hunger (n=1). There were 20 (67.0%) left-sided dislocations and 9 (31.0%) right-sided dislocations. Closed reduction was performed in all patients with post-intubation AD (excluding Patients 6 and 26), seven of whom also received aerosol inhalation therapy. Among these, 8 patients underwent closed reduction with intravenous anesthesia, compared to 19 patients managed under local anesthesia. Two patients who failed to achieve vocal improvement after the initial closed reduction under local anesthesia underwent a repeat closed reduction procedure with intravenous anesthesia. The time from primary surgical intervention to closed reduction varied widely across the cohort, spanning 1 to 43 days, with a mean of 9.9 ± 10.5 days. Vocal outcomes were categorized as follows: complete recovery in 3 patients, significant improvement in 15, mild improvement in 8, and no improvement in 1 case (corresponding to the patient who declined closed reduction). Due to mortality caused by pre-existing conditions in one case (patient 1), vocal recovery outcomes could not be evaluated. And one was lost to follow-up (patient 26 who also declined closed reduction). A chi-square test was conducted to compare the time interval from symptom onset to surgical intervention across vocal recovery categories, with exclusion of two patients declining closed reduction and one mortality (Table 2). Closed reduction intervention within the critical 7-day window achieved the improved vocal outcomes (12/18, 66.7%) higher than delayed management beyond this period (3/8, 37.5%). There was no significant association emerged between treatment timing and vocal recovery categories (P=0.33). Discussion In a single-center retrospective study conducted over a 3-year period, 29 (0.03%) of 101,204 patients who underwent surgery under general anesthesia with endotracheal intubation experienced AD. The incidence in our population is similar to or smaller than the incidences reported previously [3, 10, 11] . Although it is widely believed that the actual incidence is higher than the numbers reflect [1] , improved preventive awareness of AD after endotracheal intubation have contributed to reducing the incidence. Various causes can induce AD, including endotracheal intubation, insertion of the intraoperative nasogastric tube, laryngoscope, or laryngeal trauma [12] . And it reported that a trainee anesthesiologist with < 2 years of experience had a higher incidence of postoperative hoarseness than a senior anesthesiologist [13] . However, in our series, 18 (62%) patients were intubated by senior anesthesiologist, no significant association between anesthesiologists' expertise and postintubation AD. This may be attributed to the widespread adoption of GlideScope. As an intubation video laryngoscope providing enhanced laryngeal visualization [14] , GlideScope has demonstrated efficacy in minimizing vocal cord dysfunction after endotracheal intubation [15] . Prolonged abdominal procedures (>180 minutes) with intraoperative nasogastric intubation demonstrated significant association with AD [6] . Notably in this study, 65.5% (19/29) patients undergone the endotracheal intubation for abdominal surgery, while 75.9% (22/29) underwent upper airway instrumentation (nasogastric tube or transesophageal echocardiography probe placement), the mean operation time was 264.7 ± 126.0 minutes, these three perioperative factors collectively constituted the primary risk profile for AD. Hoarseness emerged as the predominant postintubation voice disorder across the literature reviewed [2] and our current series. Previous studies have identified several predictors of hoarseness following endotracheal intubation [16] , with female sex being consistently associated with this complication [16, 17] . However, our investigation did not demonstrate this association. Prior studies have demonstrated a higher incidence of left-sided endotracheal tube dislocations compared to right-sided dislocations [9, 18] , a phenomenon attributed to the right-side holding of the endotracheal tube or nasogastric tube favored by many anesthetists. This finding was corroborated in our series, with left-sided dislocation observed in 20 of 29 cases (67.0%). Closed reduction serves as the primary clinical intervention for AD [8, 19] , with the therapeutic objectives focused on restoring physiological vocal fold mobility, achieving complete glottic closure, and normalizing phonatory function. In this study, all patients with AD following endotracheal intubation underwent closed reduction via direct laryngoscopy under either local or general anesthesia. Notably, general anesthesia exhibited superior clinical efficacy, as evidenced by two patients requiring conversion to general anesthesia after unsuccessful initial attempts under local anesthesia. Current evidence remains controversial regarding the time to treatment, some studies suggest that early intervention is paramount [8, 20] , while others has demonstrated that a good voice result can be obtained even with late surgical intervention [2, 9] . In our study, closed reduction intervention within the critical 7-day window showed the improved phonatory outcomes (12/18, 66.7%) higher than delayed management beyond this period (3/8, 37.5%), though there is no significant association emerged between treatment timing and vocal recovery (P=0.33). Time to surgical treatment might have prognostic significance in post-intubation AD patients with adequate sample sizes. Although this study is valuable because it summarizes the features of AD after the endotracheal intubation, there were some limitations worthy of note. Firstly, it was a single-center retrospective study which might have potential for selection bias. Secondly, although we reviewed 29 cases in the last three years, it was insufficient due to heterogeneity resulting from different anesthesiologists, surgeons, and patients. Finally, other treatment of AD, such as the injection of botulinum toxin, fat injected lateral to the thyroarytenoid, steroid injected into the cricoarytenoid joint did not occur in this study, which might affect the vocal outcomes. Conclusions In conclusion, we summarize our experiences of AD after the endotracheal intubation. Based on these features and experiences, although the incidence rate is relatively low, we recommend clinicians should maintain heightened vigilance in high-risk scenarios characterized by prolonged surgical duration (>180 minutes), abdominal surgery, and intraoperative oropharyngeal tube placement. Even if there is no significant association between treatment timing and vocal recovery, we recommend earlier intervention. Declarations Ethics approval and consent to participate The study was approved by the Ethical Committee of Ningbo No.2 Hospital with consent waived (Approval no: PJ-NBEY-KY-2025-104-01). All methods followed the Declaration of Helsinki. Clinical Trial Number Not applicable. Consent for publication Not applicable. Data availability The datasets used and analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare no competing interests. Funding This work was funded by the Project of Ningbo Health Branding Subject, Grant Number: PPXK2024-05. Author contributions Conception and design: all authors Data collection: En-ci Liu, Cheng Kang and Wei Qi Data analysis and interpretation: Guo-rong Wu, Jun-ping Chen and Wei Qi Drafting article: En-ci Liu, Wei Qi Critical revision of article: all authors Final approval of manuscript: all authors Acknowledgements Not applicable. References Sataloff RT, Bough ID, Jr., Spiegel JR: Arytenoid dislocation: diagnosis and treatment . Laryngoscope 1994, 104 (11 Pt 1):1353-1361. Rubin AD, Hawkshaw MJ, Moyer CA, Dean CM, Sataloff RT: Arytenoid cartilage dislocation: a 20-year experience . J Voice 2005, 19 (4):687-701. Yamanaka H, Hayashi Y, Watanabe Y, Uematu H, Mashimo T: Prolonged hoarseness and arytenoid cartilage dislocation after tracheal intubation . Br J Anaesth 2009, 103 (3):452-455. Mencke T, Echternach M, Kleinschmidt S, Lux P, Barth V, Plinkert PK, Fuchs-Buder T: Laryngeal morbidity and quality of tracheal intubation: a randomized controlled trial . Anesthesiology 2003, 98 (5):1049-1056. Szigeti CL, Baeuerle JJ, Mongan PD: Arytenoid dislocation with lighted stylet intubation: case report and retrospective review . Anesth Analg 1994, 78 (1):185-186. Kong X, Song Y, Wang L, He G, Ma C, Zhao R, Wang M, Shi L, Cui W: Risk factors of arytenoid dislocation after endotracheal intubation: A propensity-matched analysis . Laryngoscope Investig Otolaryngol 2022, 7 (6):1979-1986. Alalyani NS, Alhedaithy AA, Alshammari HK, AlHajress RI, Alelyani RH, Alshammari MF, Alhalafi AH, Alharbi A, Aldabal N: Incidence and Risk Factors of Arytenoid Dislocation Following Endotracheal Intubation: A Systematic Review and Meta-Analysis . Cureus 2024, 16 (8):e67917. Lee SW, Park KN, Welham NV: Clinical features and surgical outcomes following closed reduction of arytenoid dislocation . JAMA Otolaryngol Head Neck Surg 2014, 140 (11):1045-1050. Lee DH, Yoon TM, Lee JK, Lim SC: Clinical Characteristics of Arytenoid Dislocation After Endotracheal Intubation . J Craniofac Surg 2015, 26 (4):1358-1360. Komorn RM, Smith CP, Erwin JR: Acute laryngeal injury with short-term endotracheal anesthesia . Laryngoscope 1973, 83 (5):683-690. Jang EA, Yoo KY, Lee S, Song SW, Jung E, Kim J, Bae HB: Head-neck movement may predispose to the development of arytenoid dislocation in the intubated patient: a 5-year retrospective single-center study . BMC Anesthesiol 2021, 21 (1):198. Okazaki Y, Ichiba T, Higashi Y: Unusual cause of hoarseness: Arytenoid cartilage dislocation without a traumatic event . Am J Emerg Med 2018, 36 (1):172 e171-172 e172. Kamimura Y, Nakanishi T, Sato AB, Osaga S, Kako E, Sobue K: Effects of the anesthesiologist's experience on postoperative hoarseness after double-lumen endotracheal tube intubation: a single-center propensity score-matched analysis . BMC Anesthesiol 2020, 20 (1):278. Sun DA, Warriner CB, Parsons DG, Klein R, Umedaly HS, Moult M: The GlideScope Video Laryngoscope: randomized clinical trial in 200 patients . Br J Anaesth 2005, 94 (3):381-384. Elbeialy MA, Maarouf AM, Alansary AM: GlideScope(R) versus Macintosh laryngoscope for assessment of post-thyroidectomy vocal cord dysfunction: prospective randomized study . Minerva Anestesiol 2020, 86 (5):518-526. Maruyama K, Sakai H, Miyazawa H, Toda N, Iinuma Y, Mochizuki N, Hara K, Otagiri T: Sore throat and hoarseness after total intravenous anaesthesia . Br J Anaesth 2004, 92 (4):541-543. Christensen AM, Willemoes-Larsen H, Lundby L, Jakobsen KB: Postoperative throat complaints after tracheal intubation . Br J Anaesth 1994, 73 (6):786-787. Quick CA, Merwin GE: Arytenoid dislocation . Arch Otolaryngol 1978, 104 (5):267-270. Wu X, Mao W, Zhang J, Wei C: Treatment Outcomes of Arytenoid Dislocation by Closed Reduction: A Multidimensional Evaluation . J Voice 2021, 35 (3):463-467. Frosolini A, Caragli V, Badin G, Franz L, Bartolotta P, Lovato A, Vedovelli L, Genovese E, de Filippis C, Marioni G: Optimal Timing and Treatment Modalities of Arytenoid Dislocation and Subluxation: A Meta-Analysis . Medicina (Kaunas) 2025, 61 (1). Tables Tables 1 and 2 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Tables.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7072258","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":493520683,"identity":"a5408c5f-4ed6-49b3-b1a7-fce62f365d6b","order_by":0,"name":"En-ci Liu","email":"","orcid":"","institution":"Ningbo No. 2 Hospital","correspondingAuthor":false,"prefix":"","firstName":"En-ci","middleName":"","lastName":"Liu","suffix":""},{"id":493520684,"identity":"9e169f02-a2a7-474c-95b8-e5642834cf76","order_by":1,"name":"Guo-rong Wu","email":"","orcid":"","institution":"Ningbo No. 2 Hospital","correspondingAuthor":false,"prefix":"","firstName":"Guo-rong","middleName":"","lastName":"Wu","suffix":""},{"id":493520686,"identity":"a1be9132-417c-4266-8b7d-4502fe55714e","order_by":2,"name":"Cheng Kang","email":"","orcid":"","institution":"Ningbo No. 2 Hospital","correspondingAuthor":false,"prefix":"","firstName":"Cheng","middleName":"","lastName":"Kang","suffix":""},{"id":493520689,"identity":"d249cf02-dc38-40f2-998a-e9d6c7aedbb1","order_by":3,"name":"Jun-ping Chen","email":"","orcid":"","institution":"Ningbo No. 2 Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jun-ping","middleName":"","lastName":"Chen","suffix":""},{"id":493520690,"identity":"8cf072f9-4646-4ce6-90f1-2c421060ddfe","order_by":4,"name":"Wei Qi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAx0lEQVRIiWNgGAWjYPACNjs29sbGhx9I0MKXzM9zuNlYggQtcowzZ6S3CfAQZfzx5mMSHyrMmA1uPmxjkGCwk9NtIKBF8syxNMkZZ9L4DG4ntj0oYEg2NjtAQIvBjRyz27xtx5iBWtoNJBgOJG4jqOX++2+3//77z7jh5sE2CR6itNzgYbvN2MAG9D4jkVokz6SZ/+w5xgYM5ERgIBsQ4Re+44cfG/yoAUXl8YcPP1TYyRHUwoCqwICQckwto2AUjIJRMAqwAADBKUZqb/bmIAAAAABJRU5ErkJggg==","orcid":"","institution":"Ningbo No. 2 Hospital","correspondingAuthor":true,"prefix":"","firstName":"Wei","middleName":"","lastName":"Qi","suffix":""}],"badges":[],"createdAt":"2025-07-08 08:08:26","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7072258/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7072258/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":92614215,"identity":"a9a25871-3649-44e0-8ebc-1a6ffb1e76c4","added_by":"auto","created_at":"2025-10-01 17:16:39","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1171869,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7072258/v1/9d7abbb3-12e5-4617-81fa-e46f4b5d11e9.pdf"},{"id":88264681,"identity":"70a42700-cc0a-49ce-ab2c-76208392f39e","added_by":"auto","created_at":"2025-08-04 16:06:01","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":22491,"visible":true,"origin":"","legend":"","description":"","filename":"Tables.docx","url":"https://assets-eu.researchsquare.com/files/rs-7072258/v1/46debbe16846db39d45cc273.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clinical features of arytenoid dislocation after endotracheal intubation: a 3-year retrospective single-center study","fulltext":[{"header":"Background","content":"\u003cp\u003eArytenoid dislocation (AD), a rare laryngeal injury involving displacement of the arytenoid cartilage from the cricoarytenoid joint, disrupts vocal fold function and may cause hoarseness, dysphagia, or aspiration if untreated\u003csup\u003e[1, 2]\u003c/sup\u003e. Endotracheal intubation, a common airway intervention in anesthesia practice, poses a risk of AD via direct trauma or duration of intubation\u003csup\u003e[3]\u003c/sup\u003e, which is critical in anesthesia practice due to potential iatrogenic harm[4]. Previous reports suggest that the incidence of AD occurring in less than 0.1% of patients after general anesthesia\u003csup\u003e[3, 5]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eThe current literature focuses on the risk factors of AD after endotracheal intubation\u003csup\u003e[6, 7]\u003c/sup\u003e, and treatment timing remain controversy\u003csup\u003e[8, 9]\u003c/sup\u003e. Therefore, clarifying the clinical features of AD after endotracheal intubation is crucial to guide timely treatment and improve patients’ satisfaction after anesthesia.\u003c/p\u003e\n\u003cp\u003eIn this article, our experiences of AD after endotracheal intubation in 29 cases are presented to emphasize the perioperative clinical characteristics, especially evaluating the treatment timing and vocal outcomes.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was reviewed and approved by the Institutional Review Board (IRB) of Ningbo No.2 Hospital (Approval Number: PJ-NBEY-KY-2025-104-01), with a waiver of informed consent due to its retrospective design. All procedures were conducted in accordance with the ethical standards of the Declaration of Helsinki and with relevant guidelines and regulations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSubjects\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was performed retrospectively from the perioperative period of patients who underwent endotracheal intubation had AD. Between January 2022 and December 2024, 29 patients had AD after the endotracheal intubation. These constituted 0.03% of the 101204 general anesthesia following endotracheal intubation procedures performed in this center during that period.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEvaluation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients presenting with hoarseness or pharyngeal discomfort after tracheal intubation under general anesthesia should be evaluated by an otolaryngology specialist. The clinical diagnosis of AD was investigated by the fiberoptic laryngoscopy, with computed tomography (CT) additionally performed in 6 cases for further assessment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTreatment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients diagnosed with AD underwent closed reduction as the primary intervention. Therapeutic regimens were stratified into those receiving closed reduction alone, and reduction with aerosol inhalation therapy and/or voice therapy. If the patient can tolerate it, closed reduction is performed under local anesthesia, otherwise under general anesthesia. Post-reduction joint stability was systematically evaluated through endoscopic visualization and functional phonatory assessment by an otolaryngology specialist.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatient charts, operative reports, fiberoptic laryngoscopy examinations and CT scan reports were reviewed retrospectively for each participating patient. Charts were reviewed to obtain information about etiological factors of first surgery: the surgical category, anesthesiologist experience level, endotracheal tube size, intraoperative oropharyngeal tube placement status, and operative duration; the side of dislocation (left or right), duration between first operation and closed reduction, treatment and voice results.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eVoice results were initially determined subjectively by the patient and otolaryngology specialist. Outcomes were categorized as: 1) \u003cem\u003eNormal\u003c/em\u003e- patient felt that his or her voice had returned to preinjury quality; 2) \u003cem\u003eImproved\u003c/em\u003e- significant improvement in voice was achieved, although not to preinjury quality; 3) \u003cem\u003eMild improved\u003c/em\u003e- signify minimal improvement in voice quality; 4) \u003cem\u003eUnchanged\u003c/em\u003e - no improvement in voice quality.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eResults were calculated and reported as the number (percentages) and mean (standard deviation). The Mann–Whitney test was used for continuous variables, and the Chi-square test was used for categorical variables. A \u003cem\u003eP\u003c/em\u003e value less than 0.05 was considered statistically significant. Statistical analyses were performed using SPSS version 29.0 (SPSS Inc, Chicago, Illinois, USA).\u003c/p\u003e"},{"header":"Results ","content":"\u003cp\u003eTable 1 summarizes the demographic characteristics, surgical details, endotracheal intubations, treatments, and vocal outcomes. The study group of 29 patients included 17 male patients (58.6%) and 12 female patients (41.4%). The age of the patients ranged between 29 and 89 years with a mean of 66.2 ± 12.7 years. The mean BMI was 23.06 ± 3.07. The patients had undergone the endotracheal intubation for abdominal surgery (n=19), video-assisted thoracoscopic surgery (n=4), head and neck surgery (n=3), and cardiac surgery\u0026nbsp;(n=3). A total of 11 patients were intubated by the resident anesthetist and 18 patients by the staff anesthetist. All intubations were performed without technical difficulties. Of the intubations performed by resident anesthetists, first-year residents accounted for 45.4% (5/11), second-year residents for 18.2% (2/11), and third-year residents for 36.4% (4/11). An intraoperative nasogastric tube or transesophageal echocardiography probe was placed in 75.9% of patients. The operation time ranged between 105 and 626 minutes with a mean of 264.7 ± 126.0 minutes.\u003c/p\u003e\n\u003cp\u003eThe most common symptom was hoarseness (n=21), followed by dysphagia (n=7), odynophagia (n=3), decreased volume (n=2), vocal fatigue (n=1), loss of volume (n=1), and air hunger (n=1). There were 20 (67.0%) left-sided dislocations and 9 (31.0%) right-sided dislocations. Closed reduction was performed in all patients with post-intubation AD (excluding Patients 6 and 26), seven of whom also received aerosol inhalation therapy. Among these, 8 patients underwent closed reduction with intravenous anesthesia, compared to 19 patients managed under local anesthesia. Two patients who failed to achieve vocal improvement after the initial closed reduction under local anesthesia underwent a repeat closed reduction procedure with intravenous anesthesia. The time from primary surgical intervention to closed reduction varied widely across the cohort, spanning 1 to 43 days, with a mean of 9.9 ± 10.5 days.\u003c/p\u003e\n\u003cp\u003eVocal outcomes were categorized as follows: complete recovery in 3 patients, significant improvement in 15, mild improvement in 8, and no improvement in 1 case (corresponding to the patient who declined closed reduction). Due to mortality caused by pre-existing conditions in one case (patient 1), vocal recovery outcomes could not be evaluated. And one was lost to follow-up (patient 26 who also declined closed reduction). A chi-square test was conducted to compare the time interval from symptom onset to surgical intervention across vocal recovery categories, with exclusion of two patients declining closed reduction and one mortality (Table 2). Closed reduction intervention within the critical 7-day window achieved the improved vocal outcomes (12/18, 66.7%) higher than delayed management beyond this period (3/8, 37.5%). There was no significant association emerged between treatment timing and vocal recovery categories (P=0.33).\u003c/p\u003e"},{"header":"Discussion ","content":"\u003cp\u003eIn a single-center retrospective study conducted over a 3-year period, 29 (0.03%) of 101,204 patients who underwent surgery under general anesthesia with endotracheal intubation experienced AD. The incidence in our population is similar to or smaller than the incidences reported previously\u003csup\u003e[3, 10, 11]\u003c/sup\u003e. Although it is widely believed that the actual incidence is higher than the numbers reflect\u003csup\u003e[1]\u003c/sup\u003e, improved preventive awareness of AD after endotracheal intubation have contributed to reducing the incidence.\u003c/p\u003e\n\u003cp\u003eVarious causes can induce AD, including endotracheal intubation, insertion of the intraoperative nasogastric tube, laryngoscope, or laryngeal trauma\u003csup\u003e[12]\u003c/sup\u003e. And it reported that a trainee anesthesiologist with \u0026lt; 2 years of experience had a higher incidence of postoperative hoarseness than a senior anesthesiologist\u003csup\u003e[13]\u003c/sup\u003e. However, in our series, 18 (62%) patients were intubated by senior anesthesiologist, no significant association between anesthesiologists' expertise and postintubation AD. This may be attributed to the widespread adoption of GlideScope. As an intubation video laryngoscope providing enhanced laryngeal visualization\u003csup\u003e[14]\u003c/sup\u003e, GlideScope has demonstrated efficacy in minimizing vocal cord dysfunction after endotracheal intubation\u003csup\u003e[15]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eProlonged abdominal procedures (\u0026gt;180 minutes) with intraoperative nasogastric intubation demonstrated significant association with AD\u003csup\u003e[6]\u003c/sup\u003e. Notably in this study, 65.5% (19/29) patients undergone the endotracheal intubation for abdominal surgery, while 75.9% (22/29) underwent upper airway instrumentation (nasogastric tube or transesophageal echocardiography probe placement), the mean operation time was 264.7 ± 126.0 minutes, these three perioperative factors collectively constituted the primary risk profile for\u0026nbsp;AD.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHoarseness emerged as the predominant postintubation voice disorder across the literature reviewed\u003csup\u003e[2]\u003c/sup\u003e and our current series. Previous studies have identified several predictors of hoarseness following endotracheal intubation\u003csup\u003e[16]\u003c/sup\u003e, with female sex being consistently associated with this complication\u003csup\u003e[16, 17]\u003c/sup\u003e. However, our investigation did not demonstrate this association. Prior studies have demonstrated a higher incidence of left-sided endotracheal tube dislocations compared to right-sided dislocations\u003csup\u003e[9, 18]\u003c/sup\u003e, a phenomenon attributed to the right-side holding of the endotracheal tube or nasogastric tube favored by many anesthetists. This finding was corroborated in our series, with left-sided dislocation observed in 20 of 29 cases (67.0%).\u003c/p\u003e\n\u003cp\u003eClosed reduction serves as the primary clinical intervention for AD\u003csup\u003e[8, 19]\u003c/sup\u003e, with the therapeutic objectives focused on restoring physiological vocal fold mobility, achieving complete glottic closure, and normalizing phonatory function. In this study, all patients with AD following endotracheal intubation underwent closed reduction via direct laryngoscopy under either local or general anesthesia. Notably, general anesthesia exhibited superior clinical efficacy, as evidenced by two patients requiring conversion to general anesthesia after unsuccessful initial attempts under local anesthesia.\u003c/p\u003e\n\u003cp\u003eCurrent evidence remains controversial regarding the time to treatment, some studies suggest that early intervention is paramount\u003csup\u003e[8, 20]\u003c/sup\u003e, while others has demonstrated that a good voice result can be obtained even with late surgical intervention\u003csup\u003e[2, 9]\u003c/sup\u003e. In our study, closed reduction intervention within the critical 7-day window showed the improved phonatory outcomes (12/18, 66.7%) higher than delayed management beyond this period (3/8, 37.5%), though there is no significant association emerged between treatment timing and vocal recovery (P=0.33). Time to surgical treatment might have\u0026nbsp;prognostic significance in post-intubation AD patients with adequate sample sizes.\u003c/p\u003e\n\u003cp\u003eAlthough this study is valuable because it summarizes the features of AD after the endotracheal intubation, there were some limitations worthy of note. Firstly, it was a single-center retrospective study which might have potential for selection bias. Secondly, although we reviewed 29 cases in the last three years, it was insufficient due to heterogeneity resulting from different anesthesiologists, surgeons, and patients. Finally, other treatment of AD, such as the injection of botulinum toxin, fat injected lateral to the thyroarytenoid, steroid injected into the cricoarytenoid joint did not occur in this study, which might affect the vocal outcomes.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn conclusion, we summarize our experiences of AD after the endotracheal intubation. Based on these features and experiences, although the incidence rate is relatively low, we recommend clinicians should maintain heightened vigilance in high-risk scenarios characterized by prolonged surgical duration (\u0026gt;180 minutes), abdominal surgery, and intraoperative oropharyngeal tube placement. Even if there is no significant association between treatment timing and vocal recovery, we recommend earlier intervention.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Ethical Committee of Ningbo No.2 Hospital with consent waived (Approval no: PJ-NBEY-KY-2025-104-01). All methods followed the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was funded by the Project of Ningbo Health Branding Subject, Grant Number: PPXK2024-05.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConception and design: all authors\u003c/p\u003e\n\u003cp\u003eData collection: En-ci Liu, Cheng Kang and Wei Qi\u003c/p\u003e\n\u003cp\u003eData analysis and interpretation: Guo-rong Wu, Jun-ping Chen and Wei Qi\u003c/p\u003e\n\u003cp\u003eDrafting article: En-ci Liu, Wei Qi\u003c/p\u003e\n\u003cp\u003eCritical revision of article: all authors\u003c/p\u003e\n\u003cp\u003eFinal approval of manuscript: all authors\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSataloff RT, Bough ID, Jr., Spiegel JR: \u003cstrong\u003eArytenoid dislocation: diagnosis and treatment\u003c/strong\u003e. \u003cem\u003eLaryngoscope \u003c/em\u003e1994, \u003cstrong\u003e104\u003c/strong\u003e(11 Pt 1):1353-1361.\u003c/li\u003e\n\u003cli\u003eRubin AD, Hawkshaw MJ, Moyer CA, Dean CM, Sataloff RT: \u003cstrong\u003eArytenoid cartilage dislocation: a 20-year experience\u003c/strong\u003e. \u003cem\u003eJ Voice \u003c/em\u003e2005, \u003cstrong\u003e19\u003c/strong\u003e(4):687-701.\u003c/li\u003e\n\u003cli\u003eYamanaka H, Hayashi Y, Watanabe Y, Uematu H, Mashimo T: \u003cstrong\u003eProlonged hoarseness and arytenoid cartilage dislocation after tracheal intubation\u003c/strong\u003e. \u003cem\u003eBr J Anaesth \u003c/em\u003e2009, \u003cstrong\u003e103\u003c/strong\u003e(3):452-455.\u003c/li\u003e\n\u003cli\u003eMencke T, Echternach M, Kleinschmidt S, Lux P, Barth V, Plinkert PK, Fuchs-Buder T: \u003cstrong\u003eLaryngeal morbidity and quality of tracheal intubation: a randomized controlled trial\u003c/strong\u003e. \u003cem\u003eAnesthesiology \u003c/em\u003e2003, \u003cstrong\u003e98\u003c/strong\u003e(5):1049-1056.\u003c/li\u003e\n\u003cli\u003eSzigeti CL, Baeuerle JJ, Mongan PD: \u003cstrong\u003eArytenoid dislocation with lighted stylet intubation: case report and retrospective review\u003c/strong\u003e. \u003cem\u003eAnesth Analg \u003c/em\u003e1994, \u003cstrong\u003e78\u003c/strong\u003e(1):185-186.\u003c/li\u003e\n\u003cli\u003eKong X, Song Y, Wang L, He G, Ma C, Zhao R, Wang M, Shi L, Cui W: \u003cstrong\u003eRisk factors of arytenoid dislocation after endotracheal intubation: A propensity-matched analysis\u003c/strong\u003e. \u003cem\u003eLaryngoscope Investig Otolaryngol \u003c/em\u003e2022, \u003cstrong\u003e7\u003c/strong\u003e(6):1979-1986.\u003c/li\u003e\n\u003cli\u003eAlalyani NS, Alhedaithy AA, Alshammari HK, AlHajress RI, Alelyani RH, Alshammari MF, Alhalafi AH, Alharbi A, Aldabal N: \u003cstrong\u003eIncidence and Risk Factors of Arytenoid Dislocation Following Endotracheal Intubation: A Systematic Review and Meta-Analysis\u003c/strong\u003e. \u003cem\u003eCureus \u003c/em\u003e2024, \u003cstrong\u003e16\u003c/strong\u003e(8):e67917.\u003c/li\u003e\n\u003cli\u003eLee SW, Park KN, Welham NV: \u003cstrong\u003eClinical features and surgical outcomes following closed reduction of arytenoid dislocation\u003c/strong\u003e. \u003cem\u003eJAMA Otolaryngol Head Neck Surg \u003c/em\u003e2014, \u003cstrong\u003e140\u003c/strong\u003e(11):1045-1050.\u003c/li\u003e\n\u003cli\u003eLee DH, Yoon TM, Lee JK, Lim SC: \u003cstrong\u003eClinical Characteristics of Arytenoid Dislocation After Endotracheal Intubation\u003c/strong\u003e. \u003cem\u003eJ Craniofac Surg \u003c/em\u003e2015, \u003cstrong\u003e26\u003c/strong\u003e(4):1358-1360.\u003c/li\u003e\n\u003cli\u003eKomorn RM, Smith CP, Erwin JR: \u003cstrong\u003eAcute laryngeal injury with short-term endotracheal anesthesia\u003c/strong\u003e. \u003cem\u003eLaryngoscope \u003c/em\u003e1973, \u003cstrong\u003e83\u003c/strong\u003e(5):683-690.\u003c/li\u003e\n\u003cli\u003eJang EA, Yoo KY, Lee S, Song SW, Jung E, Kim J, Bae HB: \u003cstrong\u003eHead-neck movement may predispose to the development of arytenoid dislocation in the intubated patient: a 5-year retrospective single-center study\u003c/strong\u003e. \u003cem\u003eBMC Anesthesiol \u003c/em\u003e2021, \u003cstrong\u003e21\u003c/strong\u003e(1):198.\u003c/li\u003e\n\u003cli\u003eOkazaki Y, Ichiba T, Higashi Y: \u003cstrong\u003eUnusual cause of hoarseness: Arytenoid cartilage dislocation without a traumatic event\u003c/strong\u003e. \u003cem\u003eAm J Emerg Med \u003c/em\u003e2018, \u003cstrong\u003e36\u003c/strong\u003e(1):172 e171-172 e172.\u003c/li\u003e\n\u003cli\u003eKamimura Y, Nakanishi T, Sato AB, Osaga S, Kako E, Sobue K: \u003cstrong\u003eEffects of the anesthesiologist\u0026apos;s experience on postoperative hoarseness after double-lumen endotracheal tube intubation: a single-center propensity score-matched analysis\u003c/strong\u003e. \u003cem\u003eBMC Anesthesiol \u003c/em\u003e2020, \u003cstrong\u003e20\u003c/strong\u003e(1):278.\u003c/li\u003e\n\u003cli\u003eSun DA, Warriner CB, Parsons DG, Klein R, Umedaly HS, Moult M: \u003cstrong\u003eThe GlideScope Video Laryngoscope: randomized clinical trial in 200 patients\u003c/strong\u003e. \u003cem\u003eBr J Anaesth \u003c/em\u003e2005, \u003cstrong\u003e94\u003c/strong\u003e(3):381-384.\u003c/li\u003e\n\u003cli\u003eElbeialy MA, Maarouf AM, Alansary AM: \u003cstrong\u003eGlideScope(R) versus Macintosh laryngoscope for assessment of post-thyroidectomy vocal cord dysfunction: prospective randomized study\u003c/strong\u003e. \u003cem\u003eMinerva Anestesiol \u003c/em\u003e2020, \u003cstrong\u003e86\u003c/strong\u003e(5):518-526.\u003c/li\u003e\n\u003cli\u003eMaruyama K, Sakai H, Miyazawa H, Toda N, Iinuma Y, Mochizuki N, Hara K, Otagiri T: \u003cstrong\u003eSore throat and hoarseness after total intravenous anaesthesia\u003c/strong\u003e. \u003cem\u003eBr J Anaesth \u003c/em\u003e2004, \u003cstrong\u003e92\u003c/strong\u003e(4):541-543.\u003c/li\u003e\n\u003cli\u003eChristensen AM, Willemoes-Larsen H, Lundby L, Jakobsen KB: \u003cstrong\u003ePostoperative throat complaints after tracheal intubation\u003c/strong\u003e. \u003cem\u003eBr J Anaesth \u003c/em\u003e1994, \u003cstrong\u003e73\u003c/strong\u003e(6):786-787.\u003c/li\u003e\n\u003cli\u003eQuick CA, Merwin GE: \u003cstrong\u003eArytenoid dislocation\u003c/strong\u003e. \u003cem\u003eArch Otolaryngol \u003c/em\u003e1978, \u003cstrong\u003e104\u003c/strong\u003e(5):267-270.\u003c/li\u003e\n\u003cli\u003eWu X, Mao W, Zhang J, Wei C: \u003cstrong\u003eTreatment Outcomes of Arytenoid Dislocation by Closed Reduction: A Multidimensional Evaluation\u003c/strong\u003e. \u003cem\u003eJ Voice \u003c/em\u003e2021, \u003cstrong\u003e35\u003c/strong\u003e(3):463-467.\u003c/li\u003e\n\u003cli\u003eFrosolini A, Caragli V, Badin G, Franz L, Bartolotta P, Lovato A, Vedovelli L, Genovese E, de Filippis C, Marioni G: \u003cstrong\u003eOptimal Timing and Treatment Modalities of Arytenoid Dislocation and Subluxation: A Meta-Analysis\u003c/strong\u003e. \u003cem\u003eMedicina (Kaunas) \u003c/em\u003e2025, \u003cstrong\u003e61\u003c/strong\u003e(1).\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 and 2 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Arytenoid dislocation, Endotracheal intubation, Closed reduction, Vocal recovery, Treatment timing","lastPublishedDoi":"10.21203/rs.3.rs-7072258/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7072258/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Arytenoid dislocation (AD), a rare laryngeal injury that may follow endotracheal intubation, requires systematic characterization. We aimed to review the clinical features of AD after the endotracheal intubation and evaluate the treatment timing and vocal outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eWe reviewed the medical records of patients who underwent operation under general anesthesia with endotracheal intubation from January 2022 to December 2024. Patient, anesthetic, and surgical factors associated with AD were analyzed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eA total of 29 patients with AD were identified. The patients had undergone the endotracheal intubation for abdominal surgery (n=19), video-assisted thoracoscopic surgery (n=4), head and neck surgery (n=3), and cardiac surgery (n=3). A total of 11 patients were intubated by the resident anesthetist and 18 patients by the staff anesthetist. An intraoperative nasogastric tube or transesophageal echocardiography probe was placed in 75.9% of patients. The operation time ranged between 105 and 626 minutes with a mean of 264.7 ± 126.0 minutes. The most common symptom was hoarseness (n=21), followed by dysphagia (n=7), odynophagia (n=3). Left-sided dislocation observed in 20 (67.0%) cases. Closed reduction was performed as first-line therapy in confirmed AD cases. The time from primary surgical intervention to closed reduction was 9.9 ± 10.5 days. Although there was no significant association between treatment timing and vocal recovery categories, closed reduction intervention within the critical 7-day window achieved the improved vocal outcomes (66.7%) higher than delayed intervention (37.5%).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eThis study indicates that AD after the endotracheal intubation featured by prolonged surgical duration (\u0026gt;180 minutes), abdominal surgery, and concurrent nasogastric tube or transesophageal echocardiography probe placement. Even if there is no significant association between treatment timing and vocal recovery, we recommend earlier intervention.\u003c/p\u003e","manuscriptTitle":"Clinical features of arytenoid dislocation after endotracheal intubation: a 3-year retrospective single-center study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-04 16:05:57","doi":"10.21203/rs.3.rs-7072258/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"389229b6-8483-44ce-bd68-24524e911379","owner":[],"postedDate":"August 4th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-26T12:30:30+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-04 16:05:57","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7072258","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7072258","identity":"rs-7072258","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}