ENT

Laryngeal stenosis
 Clssification
Clssificationofofthe
thelaryngeal
laryngealstenosis
stenosis

1.1.Flash-like
Flash-like(sec.
(sec.- -11hour):
hour):Foreing
Foreingbody,
body,trauma.
trauma.
2.2.Acute
Acute(1(1hour
hour––11day):day): Subcordal
Subcordallaringitis,
laringitis,Quinke
Quinkeoedema.
oedema.
3.3.Subacute
Subacute(day (day––11week):
week): Diphtheria
Diphtheriaofofthe
thelaryngis.
laryngis.
4.4.Chronic
Chronic(month
(month––years):
years):
- -tumors,
tumors,infectious
infectiousgranuloms
granuloms(scleroma,
(scleroma,tb),
tb),
- -congenital
congenital&&acquired
acquiredcicatrical
cicatricalmembranes
membranesofoftrachea,
trachea,
- -central
central&&peripherl
peripherlleasion
leasionofofinferior
inferiorlaryngeal
laryngealnerves,
nerves,
- -ankilosis
ankilosisofofcrico-arytonoideal
crico-arytonoidealjoints,
joints,
- -miopatic
miopaticparesis
paresisofoflaryngis
laryngis
5.5.Transitional
Transitionalform:form:Rhinoscleroma
Rhinoscleroma––asphyctia
asphyctiawhen
whencrust
crustisiswedged
wedgedinin
place
placeofofthe
thechronic
chronicstenosis
stenosis&&asphiksia
asphiksiaororclear
clearby
bycoughing
coughingout).
out).
 Management of the laryngeal stenosis

1. Compensated stage & 2. Subcompensated:

1. Compensated stage & 2. Subcompensated:
- dehydratation iv Glusae 20%, Ca gluconici 10%, Mg
- dehydratation iv Glusae 20%, Ca gluconici 10%, Mg
SO4 25%, Ascorbinici acid 5%;
SO4 25%, Ascorbinici acid 5%;
- diuretics: Lasics 1% iv, im;
- diuretics: Lasics 1% iv, im;
- corticosteroids iv Prednisoloni, Hydrocortisoni im.
- corticosteroids iv Prednisoloni, Hydrocortisoni im.
3. Decompensated – traсheotomy.
3. Decompensated – traсheotomy.
4. Asphixia – conicotomy.
4. Asphixia – conicotomy.
 Subchordal laryngitis

swelling of the submucose layer

in subchordal spase of laryngis
(child till 5 years)
Symptoms:
- Weak katarrhal sign at day;
- Cought at night;
- Barcling cought;
 Stenosis of laryngis.
 Management:
 Wake child up, fresh moist air, give
him warm drink, warm bath for
legs…
 Hypertonic solution iv,
 Diuretics,
 Corticosteroids,
Cr
Crofofthe
thevestibular
vestibularlaryngeal
laryngealfloor
floor- -ТТIVIV
Prevalence of the scleroma according PubMed database (846 article - 1909-2010)

Білорусь Росія
Канада
Україна
Франція
Туреччина
США
Марокко Китай
Саудівська
Єгипет Аравія Індія
Малі
Мексика

Конго
Перу
Бразилія

Австралія

Чілі

1. Prevalence of the scleroma increase according e-libriary PubMed in USA, Franch, mainly due to
emigrants (Chan T.V., Spiegel J.H., 2007; De Pontual L. et al., 2008).
2. Unfavoriable course of the scleroma in Canada, China, Poland, Mexico, Іndia, Еgypt, Тurkiy,
Australia, Panama, Peru, Brasilia, Chilki, Mali, Marocco, Saudi Arabia & Bahrain and Tunisia (Keita M.
еt. Al., 2009; Mucoz Saavedra D., Olavarria-Leiva C., 2010; Zhong Q. et al., 2009; Szyfter W. et al., 2009;
Zafar U. et al., 2008; Herrak L. et al., 2007; Abalkhail A., et al., 2007; Ben Gamra O. еt al., 2006; Simons
M.E. et al., 2006).
 Scleroma – primary chronic infectious desease due to Klebsiella Rhinoscleromatis
with specific granulomas formation, scarring & stenosing of the airways and atrofia of
the mucos membrane.

Clinical clasification of the profesor K.P.Derepa

- mainly atrofic form,

- mainly cicatrical (scar) form,
- mainly infiltrative (granulomous) form
Verification’ of the scleroma
1) Hystological (Mikulich sells);
2) Bacteriological (Klebsiella Rhinoscleromatis);
3) Serological (antibody against Klebsiella Rhinoscleromatis).

Teatment of the scleroma:

Surgical:
 - excision of the infiltates (granuloms), scar + long dilatation
(stent).
Halfsurgical:
- cryodestuction, electrocoagulation, laser evaporation,
coblation…
 + dilatation & stenting;
X-rays therapy;
 1. Antibacterial (streptomycinum, amicacynum...).
 2. Bacteriophag.
 3. Lidasae.
 4. Mucolithics.
 5. Corticosteroids
 Tracheotomy
Tracheotomy

Tracheostomy
Tracheostomytubetube
correctly
correctly
positioned
positionedininmodel.
model.
 The
Thehorizontal
horizontalskin
skinincision
incisionheld
heldopen
openby
byaa
selfretaining
selfretainingforcep.
forcep.

Tracheotomy
Tracheotomy
 The
Thestrap
strapmuscles
musclesare
areclearly
clearlyseen
seenwith
withthe
the
bloodless
bloodlessplane
planevisible
visibleininthe
themidline.
midline.
Tracheotomy
Tracheotomy
 With
Withthe
thestrap
strapmuscles
musclesretracted,
retracted,the
thethyroid
thyroid
isthmus
isthmusisisclearly
clearlyseen.
seen.

Tracheotomy
Tracheotomy
 The
Thethyroid
thyroidisthmus
isthmusisisdivided
dividedbetween
betweentwo
two
haemostats.
haemostats.

Tracheotomy
Tracheotomy
 The
Theleft
leftside
sideofofthe
theisthmus
isthmushas
hasbeen
beentransfixed,
transfixed,
with
withthe
thesecond
secondhaemostat
haemostatstill
stillininplace.
place.

Tracheotomy
Tracheotomy
 The
Thetracheal
trachealrings
ringsare
areclearly
clearlyseen
seenwith
withthe
the
cricoid
cricoidcartilage
cartilagesuperiorly.
superiorly.

Tracheotomy
Tracheotomy
 The
Thetracheal
trachealdilator
dilatorisisused
usedtotoopen
openthe
thetrachea
trachea
after
afterincising
incisingvertically
verticallythrough
throughthethetracheal
trachealrings.
rings.

Tracheotomy
Tracheotomy
 The
Theloop
loopininthe
thetracheostomy
tracheostomytape tapeisispassed
passed
through
throughthe
theflange.
flange.The
Thesilk
silksuture
sutureholding
holdingthethe
tube
tubeininplace
placeisisalso
alsoillustrated.
illustrated.

Tracheotomy
Tracheotomy
 Tracheotomy
Tracheotomy

The
Theends
endsofofthe
the
tracheostomy
tracheostomytape
tapehave
have
been
beenpulled
pulledthrough
throughthethe
loop
loopand
andtied
tiedfirmly
firmly
around
aroundthe
thepatient’s
patient’sneck.
neck.
Adjustable
Adjustableflanged
flanged
tube
tube(courtesy
(courtesyofof
Portex).
Portex).
 Complications
Complicationsofoftracheostomy
tracheostomy 11
Stage Complication
Stage
Intra-operative Complication
Haemorrhage
Intra-operative
Airway fireHaemorrhage
Airway
Injury fire
to trachea and larynx
Injury to trachea
Injury to paratrachealandstructures
larynx
Injury
Air to paratracheal structures
embolism
Air embolism
Apnoea
Apnoeaarrest
Cardiac
Cardiac arrest
Early post-operative Subcutaneous emphysema
Early post-operative Subcutaneous emphysema
Pneumothorax/pneumomediastinum
Pneumothorax/pneumomediastinum
Tube displacement
Tube displacement
Tube blockage (crusts)
Wound infection(crusts)
Tube blockage
Wound infection
Tracheal necrosis
Secondary necrosis
Tracheal haemorrhage
Swallowing haemorrhage
Secondary problems
Swallowing
Late post-operative problems
Haemorrhage
Late post-operative Haemorrhage
Granuloma formation
Granuloma formationfistula
Tracheo-oesophageal
Tracheo-oesophageal
Difficult decannulation fistula
Difficult decannulation
Tracheocutaneous fistula
Tracheocutaneous
Laryngotracheal stenosisfistula
Laryngotracheal
Tracheostomy scarstenosis
Tracheostomy scar
Hypergranulation
Hypergranulationofofaastoma.
stoma.
 Anatomy
Anatomyofofthe
thelarynx.
larynx.
Conicotomy The
Thecricothyroid
cricothyroidmembrane
membrane
Conicotomy (arrow) is bordered above by the
(arrow) is bordered above by the
thyroid cartilage and below by the
thyroid cartilage and below by the
cricoid cartilage
cricoid cartilage