Isolated Sclerosis of the Left Arytenoid Cartilage Revealed by Intermittent Dysphonia: A Case Report
Dr Zineb Berdi*, Dr Zakaria Arkoubi, Pr Razika Bencheikh, Pr Mohamed Anass Benbouzid and Pr Leila Essakalli
Abstract
Introduction: Arytenoid cartilage sclerosis is a poorly known radiologic entity, most often discovered incidentally on cervical computed tomography (CT) performed for another indication. Its main clinical relevance lies in its differential diagnosis with neoplastic cartilage invasion in patients with laryngeal cancer, but it may also occur in isolation in patients without any oncologic history, raising a diagnostic interpretation challenge.
Case Presentation: We report the case of a 54-year-old woman with no notable medical history, presenting with intermittent dysphonia evolving over approximately 4 to 5 years, without any identifiable triggering factor (no intubation, cervical trauma, or recent ENT infection) and without associated symptoms. Clinical examination was normal. Flexible nasofibroscopy showed vocal folds of normal mucosal appearance, with hypomobility of the left hemilarynx involving both the arytenoid and the ipsilateral vocal fold, the right vocal fold retaining normal mobility. Standard laboratory workup was unremarkable. Cervical CT with and without contrast injection showed a sclerotic appearance of the left arytenoid cartilage, without lysis, erosion, or associated soft-tissue process. No MRI, biopsy, or direct laryngoscopy was performed. Given this presentation suggestive of benign arytenoid cartilage sclerosis, a conservative approach was adopted, combining nasofibroscopic surveillance with speech therapy, and the patient was reassured about the benign nature of her condition.
Discussion: Arytenoid cartilage sclerosis reflects a change in laryngeal cartilage mineralization, a physiological phenomenon related to cartilage aging, but it may also indicate a local pathologic process (cricoarytenoid arthritis, granuloma, cartilaginous tumor) or a systemic disease (rheumatoid arthritis, gout, sarcoidosis). Its left-sided and female predominance, as well as its possible association with arytenoid hypomobility through cricoarytenoid joint ankylosis, are discussed in light of the available literature.
Conclusion: In the setting of chronic dysphonia with isolated arytenoid hypomobility, benign arytenoid cartilage sclerosis should be recognized as a differential diagnosis, allowing unnecessary invasive investigations to be avoided when the clinical, biological, and evolutionary context is reassuring.
