Acute Stenosis Of The Larynx


Categories: TRACHEOTOMY
Sources: A Manual Of Peroral Endoscopy And Laryngeal Surgery

Etiology.--Causes of a relatively sudden narrowing of the lumen of

the larynx and subjacent trachea are included in the following list.

Two or more may be combined.

1. Foreign body.

2. Accumulation of secretions or exudate in the lumen.

3. Distension of the tissues by air, inflammatory products, serum,

pus, etc.

4. Displacement of relatively normal tissues, as in abductor

paralysis, congenital laryngeal stridor, etcetera.

5. Neoplasms.

6. Granulomata.



Edema of the larynx may be at the glottic level, or in the

supraglottic or subglottic regions. The loose cellular tissue is most

frequently concerned in the process rather than the mucosal layer

alone. In children the subglottic area is very vascular, and swelling

quickly results from trauma or inflammation, so that acute stenosis of

the larynx in children commonly has its point of narrowing below the

cords. Dyspnea, and croupy, barking, cough with no change in the tone

or pitch of the speaking voice are characteristic signs of subglottic

stenosis. Edema may accompany inflammation of either the superficial

or deep structures of the larynx. The laryngeal lesion may be primary,

or may complicate general diseases; among the latter, typhoid fever

deserves especial mention.



Acute laryngeal stenosis complicating typhoid fever is frequently

overlooked and often fatal, for the asthenic patient makes no fight

for air, and hoarseness, if present, is very slight. The laryngeal

lesion may be due to cordal immobility from either paralysis or

inflammatory arytenoid fixation, in the absence of edema.

Perichondritis and chondritis of the laryngeal cartilages often follow

typhoid ulceration of the larynx, chronic stenosis resulting.



Laryngeal stenosis in the newborn may be due to various anomalies of

the larynx or trachea, or to traumatism of these structures during

delivery. The normal glottis in the newborn is relatively narrow, so

that even slight encroachment on its lumen produces a serious degree

of dyspnea. The characteristic signs are inspiratory indrawing of the

supraclavicular fossae, the suprasternal notch, the epigastrium, and

the lower sternum and ribs. Cyanosis is seen at first, later giving

place to pallid asphyxia when cardiac failure occurs. Little air is

heard to enter the lungs, during respiratory efforts and the infant,

becoming exhausted by the great muscular exertion, soon ceases to

breathe. Paralytic stenosis of the larynx sometimes follows difficult

forceps deliveries during which stretching or compression of the

recurrent nerves occur.



Acute laryngeal stenosis in infants, from laryngeal perichondritis,

may be a delayed result of traumatism to the laryngeal cartilages

during delivery. The symptoms usually develop within four weeks after

birth. Lues and tuberculosis are possible factors to be eliminated by

the usual methods.



Surgical Treatment of Acute Laryngeal Stenosis.--Multiple puncture

of acute inflammatory edema, while readily performed with the

laryngeal knife used through the direct laryngoscope, is an uncertain

measure of relief. Tracheotomy, if done low in the neck, will

completely relieve the dyspnea. By its therapeutic effect of rest, it

favors the rapid subsidence of the inflammation in the larynx and is

the treatment to be preferred. Intubation is treacherous and

unreliable except in diphtheritic cases; but in the diphtheritic cases

it is ideal, if constant skilled watching can be had.





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