This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (9) Citing Articles via Google Scholar Google Scholar Articles by Paulsen, F. P. Articles by Tillmann, B. N. Search for Related Content PubMed PubMed Citation Articles by Paulsen, F. P. Articles by Tillmann, B. N.

---

GENERAL ARTICLES

The Cricoarytenoid Joint Capsule and Its Relevance to Endotracheal Intubation

Department of Anatomy, Christian Albrecht University of Kiel, Kiel, Germany

Address correspondence and reprint requests to Dr. med. F. Paulsen, Department of Anatomy, Christian Albrecht University of Kiel, Olshausenstr. 40, 24098 Kiel, Germany. Address e-mail to fpaulsen{at}anat.uni-kiel.de

Impaired movement of the cricoarytenoid joint with hoarseness and immobility of the vocal ligament may occur as a consequence of endotracheal intubation. Little is known about the cricoarytenoid joint capsule and its role in intubation. We investigated the joint capsules of 48 cricoarytenoid joints by means of gross anatomy microscopy, histology, and scanning electron microscopy; 30 unfixed cadaver larynges were also subjected to attempts to simulate traumata such as those that may occur during intubation trials. The larynges were intubated with the arytenoid tip entering the lumen of the tracheal tube or extubated with the cuff of the tube only partially deflated. Subsequently, i.e., after dissecting the left and right cricoarytenoid joint from each larynx, the morphologic changes induced experimentally were analyzed by using histologic methods. The cricoarytenoid joint was found to be lined by a wide joint capsule. Unexpectedly large and intensively vascularized synovial folds projected into the joint cavity. After simulation of intubation and extubation, histologic analysis revealed injuries to the synovial folds and joint surface impressions, but no trauma or rupture of the outer joint capsule. We conclude that laxity of the joint capsule and the large synovial folds are predisposing factors for intubation trauma of the cricoarytenoid joint, potentially leading to hemarthros and finally to cricoarytenoid joint dysfunction.

Implications: The present study illustrates by morphological investigations and intubation experiments that laxity of the joint capsule and large synovial folds are predisposing factors for intubation trauma of the cricoarytenoid joint, potentially leading to hemarthrosis and finally to cricoarytenoid joint dysfunction.

This article has been cited by other articles:

				S. Vijayasekaran, R. Sances, R. Cotton, and R. G. Elluru Changes in the Cricoarytenoid Joint Induced by Intubation in Neonates Arch Otolaryngol Head Neck Surg, December 1, 2006; 132(12): 1342 - 1345. [Abstract] [Full Text] [PDF]

				S. D. Mentzelopoulos, M. Tzoufi, K. Rellos, A. S. Michalopoulos, E. Stamataki, C. Roussos, and S. G. Zakynthinos An Evaluation of McCoy Balloon Laryngoscopy in Patients With Moderate-to-Major Endotracheal Intubation Difficulty Anesth. Analg., October 1, 2005; 101(4): 1233 - 1237. [Abstract] [Full Text] [PDF]

				S. D. Mentzelopoulos, C. N. Romana, D. S. Corolanoglou, M. J. Tzoufi, and E. A. Karamichali Balloon Versus Conventional Laryngoscopy: A Comparison of Laryngoscopic Findings and Intubation Difficulty Anesth. Analg., December 1, 2000; 91(6): 1513 - 1519. [Abstract] [Full Text] [PDF]