Chronic Stenosis Of The Larynx And Trachea


Categories: CHRONIC STENOSIS OF THE LARYNX AND TRACHEA
Sources: 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.





More

;