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Medical ArticlesDr Jerome Kidder's Electro-magnetic MachineOn opening the machine-box, as it comes from the manufacturer... Symptoms Dysphagia is the most frequent complaint in cases of esophag... Small Pox - Variola This disease begins with pain in the head and back, chilly se... Notes On Nursing Tracheotomized Patients Bedside tray should contain: Duplicate cannula Scalpel ... Is Physical Culture Good For Girls? A NUMBER of women were watching a game of basket-ball... Altitude It has long been known that altitude increases the heart rate... Biliary Calculi Gravel In Liver Take A C current, strong as can be borne; and treat the infla... From The Hygienic Dictionary Autointoxication. [1] the accumulations on the bowel wall be... Elbow Joint See Armpit Swelling and Bone. ... Varioloids And Chicken-pocks _Varioloids_ and _Chicken-pocks_, are treated in the same man... Bread Wheaten In some cases the bran in whole wheaten bread and Saltcoats bi... Lessons From Nutritional Anthropology The next logical pair of questions are: how healthy could goo... About Faces WATCH the faces as you walk along the street! If you ... Brain Exercise Proper exercise for the brain is most important. But this is n... Angioneurotic Edema Angioneurotic edema involving the esophagus, may produce int... Eyes Failing Sight This often comes as the result simply of an over-wearied body ... What Keeps Us Alive The Energy in Food and Fuel. The first question that arises i... Vocal Results A whispering voice can always be had as long as air can pass... Prognosis A foreign body lodged in the esophagus may prove quickly fat... The Relative Position Of The Cranial Nasal Oral And Pharyngeal Cavities On making a section (vertically through the median line) of t... |
Treatment Of Cicatricial StenosisCategory: DECANNULATION AFTER CURE OF LARYNGEAL STENOSIS Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery A careful direct endoscopic examination is essential before deciding on the method of treatment for each particular case. Granulations should be removed. Intubated cases are usually best treated by tracheotomy and extubation before further endoscopic treatment is undertaken. A certain diagnosis as to the cause of the condition must be made by laboratory and therapeutic tests, supplemented by biopsy if necessary. Vigorous antiluetic treatment, especially with protiodide of mercury, must precede operation in all luetic cases. Necrotic cartilage is best treated by laryngostomy. Intubational dilatation will succeed in some cases. [FIG. 109.--Schema showing the author's method of laryngostomy. The hollow upward metallic branch (N) of the cannula (C) holds the rubber tube (R) back firmly against the spur usually found on the back wall of the trachea. Moreover, the air passing up through the rubber tube (R) permits the patient to talk in a loud whisper, the external orifice of the cannula being occluded most of the time with the cork (K). The rubber tubing, when large sizes are reached may extend down to the lower end of the cannula, the part C coming out through a large hole cut in the tubing at the proper distance from the lower end.] Laryngoscopic bouginage once weekly with the laryngeal bougies (Fig. 42) will cure most cases of laryngeal stenosis. For the trachea, round, silk-woven, or metallic bougies (Fig. 40) are better. [307] Laryngostomy consists in a midline division of the laryngeal and tracheal cartilages as low as the tracheotomic fistula, excision of thick cicatricial tissue, very cautious incision of the scar tissue on the posterior wall, if necessary, and the placing of the author's laryngostomy tube for dilatation (Fig. 109). Over the upward branch of the laryngostomy tube is slipped a piece of rubber tubing which is in turn anchored to the tape carrier by braided silk thread. Progressively larger sizes of rubber tubing are used as the laryngeal lumen increases in size under the absorptive influence of the continuous elastic pressure of the rubber. Several months of wearing the tube are required until dilatation and epithelialization of the open trough thus formed are completed. Painstaking after-care is essential to success. When dilatation and healing have taken place, the laryngostomy wound in the neck is closed by a plastic operation to convert the trough into a trachea by supplying an anterior wall. Intubational treatment of chronic laryngeal stenosis may be tried in certain forms of stenosis in which the cicatrices do not seem very thick. The tube is a silver-plated brass one of large size (Fig. 110). A post which screws into the anterior surface of the tube prevents its expulsion. Over the post is slipped a block which serves to keep open the tracheal fistula. Detailed discussion of these operative treatments is outside the scope of this work, but mention is made for the sake of completeness. Before undertaking any of the foregoing procedures, a careful study of the complete descriptions in Peroral Endoscopy is necessary, and a practical course of training is advisable. [FIG. 110.--The author's retaining intubation tube for treatment of chronic laryngeal stenosis. The tube (A) is introduced through the mouth, then the post (B) is screwed in through the tracheal wound. Then the block (C) is slid into the wound, the square hole in the block guarding the post against all possibility of unscrewing. If the threads of the post are properly fitted and tightly screwed up with a hemostat, however, there is no chance of unscrewing and gauze packing is used instead of the block to maintain a large fistula. The shape of the intubation tube has been arrived at after long clinical study and trials, and cannot be altered without risk of falling into errors that have been made and eliminated in the development of this shape.] Next: Decannulation After Cure Of Laryngeal Stenosis Previous: Trauma
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