E.A.

Tsvetkov

Chronic stenoses of larynx at children

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

Chronic stenosis of larynx

- Scar tissue - Acquired paresis and paralyses - Tumours and infection granulemes - Congenital developmental anomalies

50 % 18 % 25 % 7%

Diagnostics of chronic stenosis

Indirect laryngoscopy mirror, fibrolaryngoscopy,
telelaryngoscopy Direct laryngoscopy (supported microlaryngoscopy and endovideolaryngoscopy) 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

Indirect mirror laryngoscopy

Indirect fibrolaryngoscopy

Indirect telelaryngoscopy

Direct supported microlaryngoscopy

Direct supported endovideolaryngoscopy

X-ray and a computer tomography of larynx and a trachea

I. Cicatricial stenosis of larynx

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 a throat owing to: - inflammatory diseases - household, sports and operational traumas - traumatic and long intubation - tracheostomy

Role of immune system

utoimmune process is connected with collagen 2 types the basic protein cartilagenous tissue. At contact of a molecule of collagen to immune system in which sufficient suppresor reaction to development of antibodies to the given protein genetically is not incorporated, are formed autoantibodies. Parameters: an index of parity 1/2. N = 1,5. At scarring> 3,0 or 0.

Classification of cicatricial stenoses of larynx and trachea (E.A.Tsvetkov, 1991)

Prevalence Localization of cicatricial process On a department By a borrowed part A.Anterior 1. Supraglottis limited B.Posterior 2. Glottis 3.Infraglottis C. Circular 4.Laryngeal D. Entire extensive 5.Laryngeotracheali E. Total s

6.Trachealis

Total infraglottis stenosis

Methods of surgical treatment

Endoscopic(laser microsurgical,radioknife,argonplasma coagulation) Endolaryngeal with external approach(laryngotracheoplasty with endoprotesis or without) Combined

excision of scar tissues

Installation endoprotesis

Endoprotesis in laryngeal lumen

Removal endoprotesis

Laryngeal lumen after removal endoprotesis

Laser methods of surgical treatment

Condition after laser excision scar tissue infraglottis and vestibular departments of larinx

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

ne-phase laryngotracheoplasty at children of chest age

Chart circular stenosis in infraglottis

Form of transplantat from costal autocartilago

The scheme of fixing costal utocartilago on an anterior laryngotracheal wall

Circular cicatricial stenosis subfold space (before laryngotracheoplasty)

Redressation of cricoid plate at a circular cicatricial stenosis

Exposure of an arch cricoidcartilage

Intubationa tube in a gleam of larynx after a section of an arch cricoid cartilage and two rings of a trachea

Capture of a costal transplant

Formation of a transplant

Cartilagenous the costal transplant is filed to laryngotracheal a wall

Befor operation

After operation

ultistage laryngoplasty at patients of early and senior children's age

Endoprotesation after laryngoplasty with redressation of cricoid plate )

Stages of laryngoplasty

Surgical treatment after burn stenoses hypopharinx an intestinal transplant on a vascular leg

Preparation of vessels of a neck for microvascular nasthomosis

Formation of a gleam hypopharinx

Preparation of an intestinal transplant

Hypopharinx
Befor operation After operation

II. Paralytic stenoses of larynx

Neuroparalisis stenoses of larynx

Central
Peripheral
(Damages of a recurrent nerve)

Haemorrhages Gumma Syringobulbia Poliomyelitis Tick-borne encephalitis, etc.

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

Surgical treatment of paralytic stenoses

Reinervation internal guttural muscles Reconstructive laryngoplasty
fold - submucous chordarytenoidectomy - arytenoidectomy with lateralisation a voice

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

Bilateral paralysis of a throat

Laser arytenoidectomy I stage

Laser arytenoidectomy II stage

Result of treatment

III. Tumours and infectious

Papillomathosis of larynx (24 % of all good-quality formation of larynx) Ethilogy a virus of a papilloma of person VHP
(PAPOVAVIRUS) 6 and 11 type

Contributing factors: Virus infections, VHP Estrogen HLA Chronic persistent an infection

Clinically shares on: primary and recidive (it is fast recidive and slowly recidive
The basic symptoms: Disphonia phonia Attributes of a stenosis Infringement of dividing function Features at children: Arises more often after the transferred children's infections Often and roughly recidive Quickly the stenosis develops Can back develop by the period of puberty

Treatment
icroendoscopic removal of papillomas Antivirus preparations an alpha and scale

interferon, viferon, reaferon, etc. Immunomodulation preparations celandine, cycloferon, thymogen, etc. Etiotropic a preparation inidnol

Removal of papillomas

Injection of interferon

Endoscopic a picture of larynx right after treatments

Infectious granulem

Scleroma Tuberculosis Syphilis

IV. Congenital developmental anomalies of a throat

Tissue congenital developmental 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 the tissue, a being functional unit of body (compensation hyperplasia) Dischronia Congenital or postnatalis infringement of rates of development of a tissue at which there is an accelerated development of a

 Problem of chronic stenosis of larynx cleanly

surgical 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.