Chronic Stenosis Of The Larynx And Trachea
Categories: CHRONIC STENOSIS OF THE LARYNX AND TRACHEASources: A Manual Of Peroral Endoscopy And Laryngeal Surgery
The various forms of laryngeal stenosis for which tracheotomy or
intubation has been performed, and the difficulties encountered in
restoring the natural breathing, may be classified into the following
types:
1. Panic
2. Spasmodic
3. Paralytic
4. Ankylotic (arytenoid)
5. Neoplastic
6. Hyperplastic
7. Cicatricial
(a) Loss of cartilage
(b) Loss of muscular tissue
(c) Fibrous
Panic.--Nothing so terrifies a child as severe dyspnea; and the
memory of previous struggles for air, together with the greater ease
of breathing through the tracheotomic cannula than through even a
normal larynx, incites in some cases so great a degree of fear that it
may properly be called panic, when attempts at decannulation are made.
Crying and possibly glottic spasm increase the difficulties.
Spasmodic stenosis may be associated with panic, or may be excited
by subglottic inflammation. Prolonged wearing of an intubation tube,
by disturbing the normal reciprocal equilibrium of the abductors and
adductors, is one of the chief causes. The treatment for spasmodic
stenosis and panic is similar. The use of a special intubation tube
having a long antero-posterior lumen and a narrow neck, which form
allows greater action of the musculature, has been successful in some
cases. Repeated removal and replacement of the intubation tube when
dyspnea requires it may prove sufficient in the milder cases. Very
rarely a tracheotomy may be required; if so, it should be done low.
The wearing of a tracheotomic cannula permits a restoration of the
muscle balance and a subsidence of the subglottic inflammation.
Corking the cannula with a slotted cork (Fig. 111) will now restore
laryngeal breathing, after which the tracheotomic cannula may be
removed.
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