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Larynx stenosis

Stenosis of the larynx and trachea lead to severe respiratory distress until death from asphyxiation. Laryngology studies only stenosis of the larynx and upper (cervical) section of the trachea, while thoracic surgeons are involved in stenosis of the thoracic section.

Of course, there are differences in both the pathogenesis and clinic of acute and chronic laryngeal stenosis. Acute stenosis occurs most often as a result of tissue edema in the area of ​​the vestibule of the larynx, ororganic sinus. and in children and sub-folded (more correctly, sub-vocal) spaces, less often - due to a foreign body. Laryngeal tonsillitis (submucosal laryngitis) is a disease in which swelling of the vestibule of the larynx begins very quickly, and this is where the Voyachek tonsil is located. Edema can grow very quickly from several hours to 2-3 days and even lead to sudden asphyxiation. False croup (sub-folded laryngitis) occurs only in children, since they have a diameter of the inner half-ring of the thyroid cartilage much larger than the ring, and this space is made of loose fiber. Edema develops within 15-30 minutes, usually at night, during sleep, when the child takes a horizontal position. The true croup, diphtheria of the larynx, is essentially the second cause of stenosis, the foreign body of the larynx, since films form here as a result of necrosis of the mucosa, overlapping the lumen of the larynx. There are also “external” foreign bodies that externally injure the mucous membrane with subsequent edema or penetrate the lumen of the larynx and trachea, narrowing it.

According to the existing classification, stenosis is divided into:

a) lightning fast with complete closure of the glottis;

b) acute I, II and III degrees, depending on the narrowing of the glottis, respectively to 1/3 of the lumen, not more than 2/3 and more than 2/3 of the lumen.

Chronic laryngeal stenosis is not divided into degrees, because the patient’s condition here is more dependent on compensation of the patient’s respiratory function and adaptive mechanisms, their plasticity, therefore, with the same degree of stenosis, the patient’s state is very different. This is especially evident with tracheal stenosis, when respiratory failure during exertion, shortness of breath in a patient, and sometimes a doctor, explains heart failure. increased blood pressure. stagnation in the pulmonary circulation, while the patient’s mediastinal tumor already compresses the trachea to the diameter of the ballpoint pen, and only a thorough x-ray examination reveals the truth.

In the etiology of chronic stenosis of the larynx and trachea are tumors of the larynx and trachea, peacetime and wartime injuries, infectious granulomas (scleroma, syphilis and tuberculosis of the larynx). With compensated chronic stenosis, tracheotomy is rarely done, only if the acute process joins and leads to edema and a significant narrowing of the glottis. We had to observe a bakery saleswoman who underwent seven tracheotomies in 13 years, because against the background of chronic stenosis, she had acute laryngitis with suffocation in the winter due to a cold. A special kind of laryngeal stenosis as a result of paralysis of the vocal folds (one- or two-sided) due to damage to the lower larynx (recurrent) nerves, especially often with a strectomy - in 2.5 - 4% of all operated, because, as you know, the recurrent nerve passes through the thyroid gland. Other causes of this lesion are trauma, and the left recurrent nerve is syphilitic periaortitis, as this nerve bends around the aortic arch. We observed a patient with paralysis of the right vocal fold due to transection of the recurrent nerve when stabbed in the right collarbone - to the place where the nerve bends around it.

There is a conservative and surgical treatment for stenosis. The first includes the treatment of the underlying disease and stenosis proper, as a rule, the parenteral use of “resolving” agents: diuretics, antihistamines, hormones, etc. For fulminant stenosis, a special type of “throat cut”, conicotomy, horizontal dissection of the conical ligament connecting the thyroid and cricoid cartilage, it is easily groped on the neck, and when it is cut, there is no bleeding, since there are no muscles and blood vessels, and the surgeon enters the underscaped space. Lightning-fast stenosis occurs when the larynx is blocked or at the level of the larynx. where a large foreign body gets stuck when swallowing and fixes the epiglottis in the lower position (they say the person “choked”), or (more often in children) the foreign body enters the glottis, there is a spasm of the vocal folds in the middle position.
When a foreign body, threatening asphyxia, fails, stenosis usually does not occur in the trachea, but there is a risk of clogging of the bronchi and lung atelectasis. Foreign bodies are removed using a bronchoscope. If with acute stenosis of the first degree, tracheotomy is extremely rare, then, on the contrary, with stenosis of the 3rd degree, tracheotomy is absolutely indicated. Acute stenosis of the 2nd degree requires a thorough and balanced analysis to decide on a tracheotomy in order to avoid unnecessary trauma to a vital organ on the one hand and not to endanger the patient’s life itself as a possible hazard. For example, in an ENT hospital, when the duty service is fully prepared, you can observe the patient during conservative treatment and not rush to the operation, but if you need to transport such a patient, tracheotomy is mandatory.

What is a tracheotomy? This is an overlay of a stoma (“mouth”) on the trachea in three classical places - between 2-3 tracheal rings (upper), between 3-4 - middle, between 5 and 6 - lower. In the first and third cases, the isthmus of the thyroid gland is displaced up or down, and in the second case, the isthmus is dissected. The technique of tracheotomy is simple - a skin incision from the edge of the thyroid cartilage down, not reaching the jugular notch. Then the front muscles of the neck are stupidly stratified, while remembering that the stratification must be exactly in the midline. When approaching the trachea, the isthmus of the thyroid gland is determined, moves up or down, or intersects. The incision level of the trachea is outlined. According to V.I. Voyachek, one of the ligaments between the cartilaginous rings of the trachea (transverse tracheotomy) is cut across, a tracheotomy tube is inserted using a nasal mirror, the wound is not completely sutured to avoid emphysema of the neck tissue. The tube has a shield for fixing on the neck with gauze turundas, and a cotton-gauze napkin with a slot is placed under the shield. If necessary, the tube is drained by suction. A cross section of the trachea is a prophylaxis of chondro-perichondritis of cartilage rings, as shown by 70 years of experience at the V.I.Voyachek clinic. There is also a method for the longitudinal section of two cartilage of the larynx (longitudinal tracheotomy), followed by the introduction of the tube. In this case, perichondritis may develop, prolonged non-healing of the stoma after removal of the tube, cannulation, when adequate breathing is not provided without the tube. In our opinion, the choice of the Björk tracheotomy method is unsuccessful when a U-shaped window is placed with parallel sections of the tracheal rings and the interringular ligament, followed by the flap being pulled down and fixing it with sutures to the skin. Such an incision is made to exclude spontaneous prolapse of the tracheotomy tube, and in view of this new danger of suffocation (in fact, you just need to fix the tube well and correctly with a lateral tracheostomy). Such an incision leads to necrosis of the U-shaped flap of the trachea and the formation of persistent cicatricial stenosis with the need for further plastic surgery. Elimination of cicatricial stenosis of the larynx is a rather complicated intervention, which has its own rules, capabilities and difficulties. In the ENT clinic, Vmeda, together with other medical institutions of the country, a new method has been developed to eliminate laryngeal stenosis, which has been used for more than 15 years and gives good results, using the so-called endoprosthesis EG-3 of VNIIIM (Fig. 4.17) on a capron base soaked with antibiotic and orotic acid . The technique of the operation is as follows - average laryngofissure, removal of scar tissue inside the larynx or trachea, restoration of their lumen. Then, an endoprosthesis in the form of a rigid hollow nylon tube is placed in the larynx and upper part of the trachea and is fixed in the larynx by stitching the soft tissues of the neck with threads tied over buttons. A longitudinal incision is sutured tightly - with the lower tracheostomy. The prosthesis is in the larynx for 3-4 weeks, which is enough for epithelization after scar removal, then it is removed using direct laryngoscopy. After 5-7 days, when reactive phenomena disappear after removal of the endoprosthesis, a tracheotomy tube is removed, the stoma usually closes on its own. This method can eliminate not only post-traumatic stenosis, but also stenosis in patients with scleroma, cancer patients.
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Larynx stenosis

  1. Laryngeal stenosis
    DIAGNOSTICS Stenoses of the larynx differ in the rate of development and degree of compensation. According to the rate of development of laryngeal stenosis, they are divided into: - fulminant (obstruction by a large foreign body, laryngospasm), developing within a few minutes; - acute, developing within a few hours (days); -chronic. The main causes of stenosis of the larynx: -inflammatory processes in the larynx
  2. Chronic laryngeal stenosis
    The disease occurs as a result of persistent morphological changes in the larynx or adjacent areas, leading to its narrowing. It usually develops slowly and gradually. Et and about l about d and I. The causes of chronic stenosis are diverse. The most common are: 1) chondroperichondritis traumatic, infectious, radiation; 2) cicatricial membranes of the larynx; 3) dysfunction of the lower larynx
  3. Acute and chronic laryngeal stenosis
    Laryngeal stenosis is a narrowing of its lumen, which prevents air from entering the underlying airways. Acute stenosis of the larynx Acute narrowing of the airway in the larynx immediately causes severe disruption of all the basic functions of life support up to their complete shutdown and death of the patient. Acute stenosis occurs suddenly or in a comparatively short period of time.
  4. Chronic stenosis of the larynx: causes, therapeutic tactics
    Chronic stenosis occurs as a result of persistent morphological changes in the larynx or neighboring areas. Causes of chronic stenosis: • Chondroperichondritis is traumatic, infectious, radiation; • Impaired mobility of the cricoid joints: • Dysfunction of the lower throat nerves as a result of toxic neuritis, after a stumectomy, with pressure
  5. Acute stenosis of the larynx: causes, therapeutic tactics
    Causes of acute stenosis: • inflammatory processes of the larynx (lining of the laryngitis, laryngeal tonsillitis), • suppurative processes of the larynx (abscess, phlegmon, chondro-perichondritis), • swelling of the mucous membrane of the larynx of an allergic nature, • foreign body of the larynx, • true croup (with diphtheria) , other infectious diseases (measles, scarlet fever, flu), •
  6. Laryngeal stenosis. U38.7
    {foto174} Treatment outcome: Clinical criteria for improving the patient's condition: 1. Normalization of temperature. 2. Normalization of laboratory parameters. 3. Improving the clinical symptoms of the disease (pain, cough, difficulty
  8. Laryngitis with stenosis
    Laryngitis with stenosis (false croup) develops, as a rule, with acute respiratory viral infections in preschool children, rarely in adults. It is associated with swelling of the mucous membrane of the respiratory tract and spasm. Often starts at night. At first the voice becomes rough and hoarse, a barking cough appears. Then there is difficulty in breathing, it becomes noisy, the patient draws in air with effort, intercostal retraction is noted
  9. Long stenosis
    Long stenoses in the coronary arteries are atherosclerotic lesions with a length of> 20 mm (Fig. 1.113). Although the effectiveness of angioplasty with long stenoses is slightly lower than the general indices for PTCA, it is actually possible to achieve the optimal effect on average in 87% of cases (from 74 to 97%) with lesions> 20 mm long (Table 1.39). The table deals with the use of standard cylinders
  10. Stenosis of the larynx
    How do you understand "stenosis of the larynx?" Stenosis of the larynx - that is, the sounding of the enlightenment of the larynx, in order to bring to the destruction of the dying through it. Stenosis of the larynx is not an independent nosological unit. Tsei pathologichesky camp mozhe buti manifestation of the rare seizure of the larynx. Stenosis of the larynx is accompanied by a guest and a chronicle. Understandably, you can see for an hour, stretching out a certain stenosis. Gostrij stenosis
    General information Aortic stenosis is the most common cause of obstruction of the LV outflow tract. Less commonly, this obstruction is caused by hypertrophic cardiomyopathy, and even less commonly, supravalvular stenosis. Etiology of aortic stenosis: congenital pathology, rheumatism, degenerative changes. Aortic stenosis is caused either by a change in the number of valve flaps (most commonly
  12. Aortic stenosis
    Epidemiology Currently, aortic stenosis is the most frequently detected acquired heart disease in Europe and North America. Most often diagnosed with calcifying aortic stenosis (2-7%) in a population older than 65 years, more often in men. Etiology Among the etiological factors of mouth stenosis, rheumatism is rarely defined (11%). In developed countries, patients
  13. Aortic stenosis
    The obstruction of the exit from the systemic ventricle at the valve, supravalvular or subvalvular level is characteristic. The frequency of the defect, depending on the isolation criteria, is 0.04-0.48 per 1000 newborns, 2-8% among all CHD and 2.5% among critical CHD. Anatomy • Valvular stenosis (70%). The most common version of the defect, combining from various options for fusion commissures,
  14. Examination of the larynx and trachea.
    Carry out external and internal studies of the larynx and trachea. Outdoor research. It consists of examination, palpation and auscultation. With an external examination, you can notice the lowering of the head, stretching of the neck and shortness of breath, sometimes swelling is established in the larynx and trachea due to inflammation and swelling of the surrounding tissues. When examining the trachea determine the change in its shape,
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