What is cricoarytenoid disease? How can it impact anesthetic complications?
The CA joint is a true diarthrodial articulation. As such, it may be a target for the same destructive changes that can occur in other small joints in patients with RA. The degree of CA disease correlates with peripheral joint disease. Symptoms of CA involvement include tracheal pain, dysphonia, stridor, dyspnea, and dysarthria. Some patients may have minor symptoms related to synovitis, but over time develop fibrous replacement of the normal cartilage and ankylosis across the joint space. CA disease may be clinically silent, and involvement in some patients may be identified following unsuccessful attempts at endotracheal intubation by standard techniques. This can result in trauma to the adducted vocal cords, with subsequent edema, inflammation, and airway obstruction. Perioperative fiberoptic laryngoscopy is recommended for all patients with symptoms of CA disease. Treatment includes systemic or locally injected corticosteroids. Intubation under fiberoptic guidance is also recommended during surgery. Patients with severe CA disease should be considered for elective tracheostomy if the vocal cords are found to be chronically adducted.
