The posterior cricoarytenoid ligament connects the posterior surface of the cricoid cartilage to the muscular process of the arytenoid, forming the posterior capsular reinforcement of the cricoarytenoid joint. The cricoarytenoid joint allows the gliding and rotation of the arytenoid that controls vocal cord abduction and adduction.
| Origin | Upper border of the cricoid lamina |
|---|---|
| Insertion | Medial and posterior surface of the base of the arytenoid cartilage |
Posterior restraint of the cricoarytenoid joint; limits anterior arytenoid displacement; maintains arytenoid seating on the cricoid facet.
Cricoarytenoid joint fixation from post-intubation injury produces unilateral vocal cord immobility that must be distinguished from recurrent laryngeal nerve palsy. The posterior cricoarytenoid ligament becomes fibrosed in joint ankylosis. Traumatic intubation can also stretch the ligament and sublux or dislocate the arytenoid, causing hoarseness. Laryngoscopy, palpation of the arytenoid under microlaryngoscopy and laryngeal EMG differentiate neurogenic from mechanical cord immobility. Early closed reduction, or injection and manipulation, can restore mobility.
Post-intubation fibrosis of the cricoarytenoid joint and posterior ligament producing fixed unilateral cord immobility mimicking RLN palsy, distinguished by preserved EMG activity and resistance on arytenoid palpation.
Displacement of the arytenoid from the cricoid facet during traumatic intubation, causing hoarseness and abnormal arytenoid position, managed by early endoscopic reduction.
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