LECTIA Pavlov Eng

8/2/2019 LECTIA Pavlov Eng

1/67

Chronic stenoses of larynx at

children

E.A.Tsvetkov


2/67

Urgency of a problem

Weight of a condition of patients

Infringement of a vital sign breathing

Infringement of communication function fonation

Infringement of dividing function Complexity of inspection

Difficulty of regenerative surgical interventions


3/67

Chronic stenosis of larynx

- Scar tissue 50 %

- Acquired paresis and

paralyses

18 %

- Tumours and infectiongranulemes

25 %

- Congenital developmentalanomalies 7 %


4/67

Diagnostics of chronic stenosis

Indirect laryngoscopy mirror, fibrolaryngoscopy,telelaryngoscopy

Direct laryngoscopy (supported microlaryngoscopy andendovideolaryngoscopy)

Stroboscopy and the spectral analysis of a voice racheoscopy

X-ray investigation and CT

Research of function of external breath (automatic

spiromethry and the general plethismography) Immunological researches

Biopsy


5/67

Indirect mirror laryngoscopy


6/67

Indirect fibrolaryngoscopy


7/67

Indirect telelaryngoscopy


8/67

Direct supported microlaryngoscopy


9/67

Direct supported

endovideolaryngoscopy


10/67

X-ray and a computer tomography of

larynx and a trachea


11/67

I. Cicatricial stenosis of larynx


12/67

Cicatricial stenoses of larynx

Make 50 % of all chronic stenoses

39 % are necessary on subfold space

Always acquired;

utoimmune process - result from superfluous

regeneration of tissue after damage of cartilages of athroat owing to:

- inflammatory diseases

- household, sports and operational traumas

- traumatic and long intubation

- tracheostomy


13/67

Role of immune system

utoimmune process is connected with collagen 2 types the basic protein cartilagenous tissue. At contact of amolecule of collagen to immune system in whichsufficient suppresor reaction to development of

antibodies to the given protein genetically is notincorporated, are formed autoantibodies.

Parameters: an index of parity 1/2. N = 1,5.

At scarring> 3,0 or 0.


14/67

Classification of cicatricial stenoses of

larynx and trachea (E.A.Tsvetkov, 1991)

Localization of cicatricial process PrevalenceOn a department By a borrowed part

1. Supraglottis A.Anterior

limited

extensive

2. Glottis B.Posterior

3.Infraglottis C. Circular

4.Laryngeal D. Entire

5.Laryngeotracheali

s

E. Total

6.Trachealis


15/67


16/67

Total infraglottis stenosis


17/67

Methods of surgical treatment

Endoscopic(laser microsurgical,radioknife,argon-plasma coagulation)

Endolaryngeal with external

approach(laryngotracheoplasty with endoprotesisor without)

Combined


18/67


19/67

excision ofscar tissues


20/67

Installation

endoprotesis


21/67

Endoprotesis in laryngeal lumen


22/67

Removal

endoprotesis


23/67

Laryngeal lumen after removal

endoprotesis


24/67

Laser methods of surgical treatment

Condition after laser excision scar tissue


25/67

Condition after laser excision scar tissue

infraglottis and vestibular departments of

larinx


26/67

Laryngotracheoplasty

One -phase

racheostoma it is not

imposed or decanulation it is

made directly after operation

Multistage

Decanulation it is made after

several stages of surgical

treatment


27/67

ne-phase laryngotracheoplasty

at children of chest age


28/67

Chart circular stenosis in

infraglottis


29/67

Form of

transplantat from

costal

autocartilago


30/67

The scheme of fixing costal

utocartilago on an anterior

laryngotracheal wall

Ci l i t i i l t i bf ld


31/67

Circular cicatricial stenosis subfold

space

(before laryngotracheoplasty)

d i f i id l i l


32/67

Redressation of cricoid plate at a circular

cicatricial stenosis


33/67


34/67

Exposure of an arch cricoidcartilage

Intubationa tube in a gleam of larynx after a section of an arch cricoid


35/67

Intubationa tube in a gleam of larynx after a section of an arch cricoid

cartilage and two rings of a trachea

C t f t l t l t


36/67

Capture of a costal transplant


37/67

Formation of a transplant


38/67

Cartilagenous the costal transplant is filed to laryngotracheal a

wall


39/67


40/67


41/67

Befor operation After operation


42/67

ultistage laryngoplasty

at patients of early and senior

children's age


43/67

Endoprotesation after laryngoplasty with

redressation of cricoid plate )


44/67

Stages of laryngoplasty

Surgical treatment after burn stenoses


45/67

hypopharinx an intestinal transplant on avascular leg

Preparation of vessels of a neck for


46/67

Preparation of vessels of a neck for

microvascular nasthomosis

F i f l h h i


47/67

Formation of a gleam hypopharinx

P i f i i l l


48/67

Preparation of an intestinal transplant

Hypopharinx


49/67

Hypopharinx

Befor operation After operation


50/67

II. Paralytic stenoses of larynx

N li i t f l


51/67

Neuroparalisis stenoses of larynx

Central

Haemorrhages

Gumma

Syringobulbia

Poliomyelitis

Tick-borne encephalitis,

etc.

Peripheral(Damages of a recurrent nerve)

Traumas of larynx and neck

Strumectomy Tumours mediastinum and a gullet

Aneurysm of an arch of an aorta Infectious diseases (a flu, a typhus, a

malaria, etc.)

Intoxication lead, arsenic, atropine,etc.

Idiophatic

S i l t t t f l ti t


52/67

Surgical treatment of paralytic stenoses

Reinervation internal guttural muscles Reconstructive laryngoplasty

- submucous chordarytenoidectomy

- arytenoidectomy with lateralisation a voicefold

- laserarytenoidectomy with a resection of avoice shoot and a back third of voice fold


53/67

Bilateral paralysis of a throat

Laser arytenoidectomy


54/67

y y

I stage

Laser arytenoidectomy


55/67

y y

II stage

Result of treatment


56/67

Result of treatment


57/67

III. Tumours and infectious

Papillomathosis of larynx(24 % of all good-quality formation of


58/67

(24 % of all good-quality formation of

larynx)

Contributing factors:

Virus infections, VHP

Estrogen HLA

Chronic persistent an infection

Ethilogy a virus of a papilloma of person VHP

(PAPOVAVIRUS) 6 and 11 type

Clinically shares on: primary and recidive (it is fast


59/67

Clinically shares on: primary and recidive (it is fast

recidive and slowly recidive

The basic symptoms:

Disphonia

phonia

Attributes of astenosis

Infringement ofdividing function

Features at children:

Arises more often after thetransferred children's infections

Often and roughly recidive Quickly the stenosis develops

Can back develop by the periodof puberty

Treatment


60/67

Treatment

icroendoscopic removal of papillomas Antivirus preparations an alpha and scaleinterferon, viferon, reaferon, etc.

Immunomodulation preparations celandine,

cycloferon, thymogen, etc. Etiotropic a preparation inidnol

Removal of papillomas


61/67

Removal of papillomas

Injection of interferon


62/67

Endoscopic a picture of larynx right after treatments


63/67

Infectious granulem


64/67

Infectious granulem

ScleromaTuberculosis

Syphilis

IV. Congenital developmental anomalies

f h


65/67

of a throat

Tissue congenital developmental

li f l


66/67

anomalies of larynx.

Displasia Qualitative infringement of a

differentiation of growth and parities of the tissue, a

being functional unit of body

Hypoplasia Quantitative reduction of thetissue, a being functional unit of body

(compensation hyperplasia)

Dischronia Congenital or postnatalisinfringement of rates of development of a tissue at

which there is an accelerated development of a


67/67

Problem of chronic stenosis of larynx cleanlysurgical problem allowing practically in all cases

to restore a gleam of larynx irrespective of

character of a stenosis in all age groups. Treatment of stenosis demands specialized

preparation of the personnel and modern,

including endoscopic technics.

LECTIA Pavlov Eng

Documents

Transcript of LECTIA Pavlov Eng