Decannulation After Cure Of Laryngeal Stenosis

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.]

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