Search

The objective of the present study was to optimize the treatment of patients with subglottic laryngeal stenosis., Material and Methods: We have examined a total of 14 patients presenting with subglottic laryngeal stenosis. The etiological factors and underlying conditions of laryngeal stenosis were the prolonged intubation in 4 patients, Wegener granulomatosis in 6 patients, and idiopathic stenosis of the larynx in 4 patients. All the patients underwent balloon dilatation with the application of the video endoscopic technique., Results: The surgical treatment of all the patients made it possible to achieve the persistent expansion of the lumen of the subglottic part of the larynx, to shorten the periods of the in-patient treatment and rehabilitation of the patients. Restenosis of laryngeal lining stenting was observed in one patient presenting with Wegener's granulomatosis which was associated with the relapse of the underlying disease.

Stenosing laryngotracheitis (SLT) affecting the children is considered to be an emergency pediatric condition associated with ENT pathology. Its treatment presents a serious challenge for otolaryngologists, pediatricians, specialists in communicable diseases, allergologists, etc. We have undertaken a retrospective analysis of the available data with a view to summarizing the tendencies in the evolution of SLT morbidity. The results of the 35 year-long experience with the use of the currently available therapeutic strategies for the treatment of the children suffering from stenosing laryngotracheitis are presented. Special emphasis is laid on the advantages of the combined treatment of the patients presenting with this condition based at a specialized infectious department with the participation of an otorhinolaryngologist.

The objective of the present study was to evaluate the effectiveness and safety of balloonlaryngotracheoplasty for the treatment of laryngeal and tracheal stenosis We undertook the analysis of the case histories of the patients presenting withlaryngotracheal stenosis who had undergone balloonlaryngotracheoplasty during the period from October 2013 till February 2016. A total of 21 histories of the patients (6 men and 15 women) were available for the investigation. Most laryngotrachealstenoses that occurred in 18 (85.7%) patients were of the idiopathic, post-tracheotomy, and post-intubation types. Their most typical localization was the subfold part of the larynx and/or the upper third of the trachea (76.2%). The length of the stenotic lesions varied from 5 to 20 mm (76.2%) and corresponded to grade III if estimated based on the Cotton-Myer classification (81%). The number of the balloonlaryngotracheoplastic procedures ranged from 1 to 4 (a total of 36 operations). The interval between the consecutive interventions varied from 1.5 to 104 (mean 20) weeks. In 16 of the 36 cases, dilatation of the narrowed portion was followed by the 4 minute application of mitomycin C at a concentration of 0.4 mg/kg. No complications were documented during the surgical interventions and in the postoperative periods. The treatment was associated with a significant enhancement of the maximum expiratory flow rate from 2±1.13 l/s to 4.23±1.9 l/s (p=0.000). The duration of the follow up period varied from 1 to 105 (mean 36.2) weeks. Mitomycin C exerted nosignificant influence on the increment of the maximum expiratory flow rate (p=0.174).

The objective of the present study was to improve the procedures for extended and restricted laser-assisted laryngoplasty in the patients presenting withparalytic laryngeal stenosis and to evaluate the outcome of the surgical interventionsdiffering in extent. The study included 51 patients (47 women and 4 men) at the age varying from 18 to 78 years. Twenty five of these patients had a tracheostoma. The examination was focused on the detection of the following characteristics: vocal fold angle, body mass index, age, specific anatomical and physiological features of the larynx, clinically significant concomitant pathologies, engagement in voice and speech professional activities as well as the influence of paramedical factors. The resulting total score was calculated. The data obtained were used to rationally plan the laser-assisted resection (either extended or restricted)of the posterior third of a vocal fold. The total score of 6 or higher always implied the necessity of extended resection whereas the overall score of 3 and less was regarded as an indication for the tissue-sparing surgery. The patients to whom the extended resection was prescribed had significantly higher physical health indices and the worse vocal function compared with the same parameters in the patients undergoing restricted resection. The spirometric characteristics of the patients in both groups were similar and either normal or slightly reduced. The characteristics of the psychic component of general health were not significantly different and corresponded to the internationally accepted normal values. It is concluded that the proposed treatment resulted in the favourable outcome in 49 of the 51 patients (96%).

This paper is designed to familiarize otorhinilaryngologists with the practical methods applied in the surgical rehabilitation of the patients presenting with paralytic laryngeal stenosis. We report the results of the treatment of 13 patients with this pathology differing in age and duration of the disease following strumectomy. Paralytic laryngeal stenosis was eliminated in 11 of the 13 patients. The favourable prognosis was strongly dependent on the time interval between the development of laryngeal paralysis and the surgical intervention. The total duration of the treatment of different patients varied from 8.5 months to 1.5 years because some of them required corrective surgery.

The problem of rehabilitation of the patients presenting with post-intubation stenosis of the larynx and trachea remains unresolved despite the development of new methods for the diagnostics and treatment of this condition. One of the indications for long-term artificial lung ventilation is the severe form of Guillaine-Barret syndrome associated with paralysis of breathing muscles, development of bulbar symptoms, and disturbances of trophic process in the skin and mucous membranes. However, prolonged (mean 26 days) artificial lung ventilation may result in the formation of many-layer stenosis of the larynx and trachea whereas disturbed trophic processes in the skin and mucous membranes coupled to inadequate innervation complicate the postoperative conditions of the patients and promote restenosis of the tracheal lumen.

Treatment tactics in patients with the extensive cicatricial stenoses of the upper third of tracheа were thoroughly analyzed. Circular resections of trachea was performed in 51 cases, 18 of those were supplemented with the distal laryngeal resection. Combination of the endoscopic treatment (tracheal bouginage and laser stenosis dissection or tracheal recanalization) and circular resection of the trachea was performed in 23 patients. Endoscopic treatment modality proved to be the temporary measure by the extensive cicatricial stenoses or supratracheostomic obliteration of the trachea, which, nevertheless, permit and facilitates further radical circular tracheal resection.

Staged development of dysbiotic disturbance of the upper airways was revealed in children suffering from stenosing laryngotracheitis in the presence of viral infection. Chronic persistent virus-bacterial inflammation of respiratory tract mucosa and resultant hypersensitivity of the airways produce chronic defects in lung ventilation in patients with recurrent stenosing laryngotracheitis. High sensitivity of the airways to histamine is related to bioelectric activity of the brain characterized by dominant irritation of the mesencephalo-diencephalic structures. Typical features of the curve flow-volume and paradoxic result of the test with broncholytic drugs verified tracheobronchial dyskinesia in patients with stenosing laryngotracheitis. Such dyskinesia promoted the recurrent disease with transformation into bronchial asthma.

External respiration function (ERF) was examined in 89 patients with stenoses of the larynx and/or trachea (50 males, 39 females, age 23-62 years). ERF was assessed by correlation between air flow and volume during forced expiration. ERF parameters before surgical treatment were not sufficiently informative as tracheostoma does not allow complete air impermeability in the system patient-apparatus-ventilation. Suturing of tracheal defect improves ERF noticeably and its results can be assessed objectively.

The treatment and follow-up data are available for 18 children (12 boys and 6 girls) with persistent scarry pharyngostenosis. The disease was first diagnosed at the age of 1 year 8 months to 12 years. Pharyngostenosis has resulted from burn induced by KMnO4 crystals. After treatment (laser destruction in 13 patients and bourginage in 4 patients) 15 patients resumed free breathing. 2 patients continue the treatment.

A study was made of blood hydrocortisone content for a period of 24 hours in the patients with congenital diseases of the heart before and after the operation, in patients with acute respiratory disease, severe pneumonia, and also with acute laryngeal stenosis of influenzal etiology. It was revealed that under pathological conditions the adrenal cortex took part in the compensatory reactions of the organism at any time of the day. As a result of this hydrocortisone concentration is steadily maintained at a definite level in the course of the 24 hours. These changes depended on the intensity of the stressor and the severity of metabolic disturbances in the organism.