Arytenoid prolapse following open airway reconstruction in adults: factors, incidence, and development of a novel grading system.

Purpose: This study aimed to study the correlation and incidence between arytenoid prolapse after open airway surgeries and its risk factors, and to classify the degree of arytenoid prolapse in the adult population.

Methods: From 2015 to 2020, we reviewed the charts of adult patients aged > 16 years who had undergone open airway surgeries at our facilities. We excluded patients with pre-existing arytenoid prolapse, limited postoperative endoscopic documentation, or loss to follow-up.

Results: The study included 23 patients; most of whom were 40 years (73.91%) and males (65.57%). Subglottic stenosis (SGS) Grade 3 (47.8%) was the most common grade prior to our intervention. No significant association was observed between the degree of SGS, comorbidity, presence of tracheostomized status, operation type (cricotracheal resection or laryngotracheal reconstruction), and the presence of arytenoid prolapse. Patients with bilateral vocal cord immobility were more likely to have arytenoid prolapse compared to those with normal vocal fold mobility (P = 0.045).

Conclusion: In adults, open airway surgeries did not correlate with arytenoid prolapse unless the patients had an immobile vocal cord. This may be due to the altered position of the arytenoid cartilage in cases of vocal fold immobility. Moreover, paralysis of the posterior cricoarytenoid muscles can lead to arytenoid apices prolapse anteromedially.