The voice box (larynx) is an essential organ for voice production and pronunciation. It is made up of nine pieces of cartilage (flexible connective tissues). The arytenoid cartilages or arytenoids are a pair of pyramid-shaped structures found in the voice box (larynx). These are located lateral to the upper border of the lamina of Adam's apple. The arytenoid cartilage is a tough, yet flexible tissue.
The arytenoids are attached to the vocal cords. They help the vocal cords to contract and relax. When the vocal cords are tense, they resonate and produce sound. The arytenoids form the cricoarytenoid joints with the cricoid cartilage. At these joints, the vocal cords can come together, move apart, tilt anteriorly or posteriorly, and rotate. These movements help control the functions of the larynx such as the pitch of the sound. The arytenoids also help in keeping the airway through the larynx open. This allows air to pass over the vocal cords.
What are the disorders of the arytenoids?
Laryngeal contact granuloma: Laryngeal contact granuloma is a common disorder that affects the medial surface of the arytenoid cartilage, precisely around the vocal process. It is currently believed to be primarily caused by factors that irritate the arytenoids. Common causes are believed to be as follows:
- Gastroesophageal reflux (backflow of food particles or gastric juice from the stomach into the food pipe)
- Intubation injury (injury during insertion of the endotracheal tube into the trachea for artificial breathing)
- Vocal cord abuse (excessive talking, throat clearing, coughing, smoking, screaming, or yelling) seen in teachers, public speakers, or any profession that requires talking
- Vocal cord misuse (speaking loudly)
Anterior or posterior arytenoid dislocation: The arytenoids are fragile and vulnerable to injury when a tube (laryngoscopy) is inserted into the larynx for artificial/assisted breathing during endotracheal intubation. An anterior or posterior arytenoid dislocation occurs most commonly during this procedure. The condition causes a hoarse voice and, possibly, severe breathing difficulty.
- Feeling of fullness in the throat when swallowing and speaking
- Hoarseness of voice
- Dyspnea (difficult breathing)
Arytenoid chondritis develops following trauma to the inner lining (mucosa) of the arytenoid cartilage or due to bacterial infection that affects the cartilage.
Laryngomalacia (soft larynx): It is a common condition seen in babies. It is caused by the floppiness of the laryngeal tissues above the vocal cords. When a child with laryngomalacia breathes in, the tissues above the vocal cords fall in toward the airway and cause partial airway obstruction. This creates stridor or noisy breathing due to the voice box getting occluded. Typically in this condition, the aryepiglottic folds, that is, the folds of tissue between the epiglottis and arytenoid cartilage, are shortened. This causes the epiglottis to curl inward and develop a shape like an omega. The tissue over the cartilage in the back of the voice box (arytenoids) gets sucked into the airway, additionally causing breathing troubles for the baby. Most cases improve as the child grows and the larynx develops. In rare cases, surgery may be needed. Surgery for this condition is called supraglottoplasty and is done by inserting an instrument called a scope.
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