Arytenoid dislocation in a patient with Marfan syndrome after undergoing aortic arch surgery

Postoperative vocal cord dysfunction can be caused by direct laryngeal trauma, nerve injury or can occur spontaneously. Patients with connective tissue disorders such as Marfan syndrome may be at higher risk for arytenoid dislocation due to tissue laxity. A woman in the 50s with Marfan syndrome underwent emergent total arch replacement for Type A aortic dissection. On endotracheal extubation, she was noted to have stridor. Fibreoptic examination was notable for an immobile right arytenoid. This case highlights the risk of arytenoid dislocation following endotracheal intubation in patients with connective tissue disorders such as Marfan syndrome. Conservative therapy can result in complete recovery without surgery. Furthermore, this case demonstrates that subsequent endotracheal intubations can be performed safely with proper airway planning. Increased awareness and further reporting are needed to understand and mitigate the risk in this vulnerable population.