VIEW THE MOBILE VERSION of www.homemedicine.ca Informational Site Network Informational
Privacy


Home


Medical Articles


Mother's Remedies


Household Tips


Medicine History


Forgotten Remedies


Search

Medical Articles

Difficulties Of Esophagoscopy

The beginner may find the esophagoscope seemingly rigidly fi...

Fever

In all fevers, to cool down the excessive heat of the patient ...

Diarrhoea

This disease consists in a looseness of the bowels, generally...

Menorrhagia Excessive Menstruation

If the menstrual flow is apt to terminate in hemorrhage, it i...

Rich Foods Brandy Beef-tea Etc

must be avoided. Involuntary starting, and the manifestation...

Wounds And Bruises

On this subject, I must necessarily be very brief. When a wou...

To Prevent Scarlet Fever

Give Belladonna at the 3d attenuation, three to six pellets, ...

Tumours

A large, soft, fleshy tumour is usually simply an accumulation...

Lues Of The Tracheobronchial Tree

Compared to laryngeal involvement, syphilis of the tracheobr...

Limbs Disjointed Or Sprained

In the case of an overstretch, or sprain, which has resulted i...

Sea-sickness

_Nux Vomica_ should be used once in about four hours, for twe...

Eruptive Cutaneous Diseases

Take A D current, pretty vigorous force in acute cases; mild ...

Necessity Of Allaying The Heat

The packs and baths should be continued, even when the patien...

The Child As An Ideal

WHILE the path of progress in the gaining of repose c...

Blood Pressure

The study of the blood pressure has become a subject of gre...

Carbolic

Readily identified by smell of tar or carbolic. Wash mouth wel...

Strychnin

The question of the advisability of strychnin is a constant s...

Contraction Of Sinews

This often occurs at the knee, bending the joint so that the p...

Asthma

If an attack comes on from sudden cold, take _Aconite_ and _I...

Head Sounds In

As the result and accompaniment of deafness these are sometime...



Decannulation After Cure Of Laryngeal Stenosis





Category: DECANNULATION AFTER CURE OF LARYNGEAL STENOSIS
Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery

In order to train the patient to breathe again through the larynx it
is necessary to occlude the cannula. This is best done by inserting a
rubber cork in the inner cannula. At first it may be necessary to make
a slot in the cork so as to permit some air to enter through the tube
to supplement the insufficient supply obtainable through the
insufficiently patulous glottis, new corks with smaller grooves being
substituted as laryngeal breathing becomes easier. Corking the cannula
is an excellent orthopedic treatment in certain cases where muscle
atrophy and partial inflammatory fixation of the cricoarytenoid joints
are etiological factors in the stenosis. The added pull of the
posterior cricoarytenoid muscles during the slight effort at
inspiration restores their tone and increases the mobility of all the
attached structures. By no other method can panic and spasmodic
stenosis be so efficiently cured.

[FIG. 111.--Illustration of corks used to occlude the cannula in
training patients to breathe through the mouth again, before
decannulation. The corks allow air leakage, the amount of which is
regulated by the use of different shapes. A smaller and still smaller
air leak is permitted until finally an ungrooved cork is tolerated. A
central hole is sometimes used instead of a slot. A, one-third cork;
B, half cork; C, three-quarter cork; D, whole cork.]

Following the subsidence of an acute laryngeal stenosis, it is my rule
to decannulate after the patient has been able to breathe through the
larynx with the cannula tightly corked for 3 days and nights. This
rule does not apply to chronic laryngeal stenosis, for while the lumen
under ordinary conditions might be ample, a slight degree of
inflammation might render it dangerously small. In these cases, many
weeks are sometimes required to determine when decannulation is safe.
A test period of a few months is advisable in most cases of chronic
laryngeal stenosis. Recurrent contractions after closure of the wound
are best treated by endoscopic bouginage. The corks are best made of
pure rubber cord, cut and ground to shape, and grooved, if desired, on
a small emery wheel (Fig. 112). The ordinary rubber corks and those
made of cork-bark should not be used because of their friability, and
the possible aspiration of a fragment into the bronchus, where rubber
particles form very irritant foreign bodies.

[FIG. 112.--This illustration shows the method of making safe corks
for tracheotomic cannulae by grinding pure rubber cord to shape on an
emery wheel. After grinding the taper, if a partial cork is desired, a
groove is ground on the angle of the wheel. If a half-cork is desired
half of the cork is ground away on the side of the wheel. Reliable
corks made in this way are now obtainable from Messers Charles J.
Pilling and Son.]






Previous: Treatment Of Cicatricial Stenosis



Add to del.icio.us Add to Reddit Add to Digg Add to Del.icio.us Add to Google Add to Twitter Add to Stumble Upon
Add to Informational Site Network
Report
Privacy
SHAREADD TO EBOOK


Viewed 1075