Diphtheria


Categories: CHRONIC STENOSIS OF THE LARYNX AND TRACHEA
Sources: A Manual Of Peroral Endoscopy And Laryngeal Surgery

Chronic postdiphtheritic stenosis may be of the panic,

spasmodic or, rarely, the paralytic types; but more often it is of

either the hypertrophic or cicatricial forms. Only too frequently the

stenosis should be called posttracheotomic rather than

postdiphtheritic, since decannulation after the subsidence of the

acute stenosis would have been easy had it not been for the sequelae

of the faulty tracheotomy. Prolonged intubation may induce either a

supraglottic or subglottic tissue hyperplasia. The supraglottic type

consists in an edematous thickening around the base of the epiglottis,

sometimes involving also the glossoepiglottic folds and the

ventricular bands. An improperly shaped or fitted tube is the usual

cause of this condition, and a change to a correct form of intubation

tube may be all that is required. Excessive polypoid tissue

hypertrophy should be excised. The less redundant cases subside under

galvanocaustic treatment, which may be preceded by tracheotomy and

extubation, or the intubation tube may be replaced after the

application of the cautery. The former method is preferable since the

patient is far safer with a tracheotomic cannula and, further, the

constant irritation of the intubation tube is avoided. Subglottic

hypertrophic stenosis consists in symmetrical turbinal-like swellings

encroaching on the lumen from either side. Cautious galvanocauterant

treatment accurately applied by the direct method will practically

always cure this condition. Preliminary tracheotomy is required in

those cases in which it has not already been done, and in the cases in

which a high tracheotomy has been done, a low tracheotomy must be the

first step in the cure. Cicatricial types of postdiphtheritic stenosis

may be seen as webs, annular cicatrices of funnel shape, or masses of

fibrous tissue causing fixation of the arytenoids as well as

encroachment on the glottic lumen. (See color plates.)



As a rule, when a convalescent diphtheritic patient cannot be

extubated two weeks after three negative cultures have been obtained

the advisability of a low tracheotomy should be considered. If a

convalescent intubated patient cough up a tube and become dyspneic a

low tracheotomy is usually preferable to forcing in an oversized

intubation tube.





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