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Chronic stenoses of larynx at
children
E.A.Tsvetkov
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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
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Chronic stenosis of larynx
- Scar tissue 50 %
- Acquired paresis and
paralyses
18 %
- Tumours and infectiongranulemes
25 %
- Congenital developmentalanomalies 7 %
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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
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Indirect mirror laryngoscopy
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Indirect fibrolaryngoscopy
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Indirect telelaryngoscopy
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Direct supported microlaryngoscopy
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Direct supported
endovideolaryngoscopy
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X-ray and a computer tomography of
larynx and a trachea
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I. Cicatricial stenosis of larynx
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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
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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.
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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
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Total infraglottis stenosis
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Methods of surgical treatment
Endoscopic(laser microsurgical,radioknife,argon-plasma coagulation)
Endolaryngeal with external
approach(laryngotracheoplasty with endoprotesisor without)
Combined
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excision ofscar tissues
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Installation
endoprotesis
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Endoprotesis in laryngeal lumen
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Removal
endoprotesis
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Laryngeal lumen after removal
endoprotesis
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Laser methods of surgical treatment
Condition after laser excision scar tissue
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Condition after laser excision scar tissue
infraglottis and vestibular departments of
larinx
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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
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ne-phase laryngotracheoplasty
at children of chest age
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Chart circular stenosis in
infraglottis
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Form of
transplantat from
costal
autocartilago
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The scheme of fixing costal
utocartilago on an anterior
laryngotracheal wall
Ci l i t i i l t i bf ld
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Circular cicatricial stenosis subfold
space
(before laryngotracheoplasty)
d i f i id l i l
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Redressation of cricoid plate at a circular
cicatricial stenosis
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Exposure of an arch cricoidcartilage
Intubationa tube in a gleam of larynx after a section of an arch cricoid
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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
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Capture of a costal transplant
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Formation of a transplant
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Cartilagenous the costal transplant is filed to laryngotracheal a
wall
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Befor operation After operation
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ultistage laryngoplasty
at patients of early and senior
children's age
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Endoprotesation after laryngoplasty with
redressation of cricoid plate )
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Stages of laryngoplasty
Surgical treatment after burn stenoses
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hypopharinx an intestinal transplant on avascular leg
Preparation of vessels of a neck for
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Preparation of vessels of a neck for
microvascular nasthomosis
F i f l h h i
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Formation of a gleam hypopharinx
P i f i i l l
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Preparation of an intestinal transplant
Hypopharinx
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Hypopharinx
Befor operation After operation
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II. Paralytic stenoses of larynx
N li i t f l
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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
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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
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Bilateral paralysis of a throat
Laser arytenoidectomy
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y y
I stage
Laser arytenoidectomy
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y y
II stage
Result of treatment
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Result of treatment
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III. Tumours and infectious
Papillomathosis of larynx(24 % of all good-quality formation of
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(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
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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
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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
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Removal of papillomas
Injection of interferon
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Endoscopic a picture of larynx right after treatments
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Infectious granulem
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Infectious granulem
ScleromaTuberculosis
Syphilis
IV. Congenital developmental anomalies
f h
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of a throat
Tissue congenital developmental
li f l
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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
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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.