자발적인 발관으로 인하여 발생된 윤상피열연골의 탈구 - 증례 보고

Dislocation of cricoarytenoid cartilage(CAC) is one of rare but serious complications of endotracheal intubation. A 46-year-old woman was admitted for removal of hypoglossal neurinoma. To maintain the airway a few more days, the authors changed orotracheal intubation into nasotracheal intubation after operation. But accidently the patient removed the nasotracheal tube with ballooning state by herself twice in the intensive care unit. One day later she was ambulatory and complained of swallowing difficulties, hoarseness, frequent coughing and respiratory difficulty due to repeated aspiration. So, videostrobolaryngoscopy and electromyelography were performed and the authors diagnosed bilateral posterior displacement of CAC due to forceful removal of the nasotracheal tube in ballooned state. Emergency operation for reduction of CAC was performed. Left side was reduced successfully but right side reduction was failed. Tracheostomy was done to maintain respiratory hygine. Fifty-five days after operation the patient was discharged in improved state. In case of dislocation of CAC, early diagnosis and reduction is mandatory. (Korean J Anesthesiol 1998; 34: 857∼862)