ISSN:
1434-4726
Source:
Springer Online Journal Archives 1860-2000
Topics:
Medicine
Notes:
Summary Stenoses of the larynx may be congenital or acquired. Congenital stenoses are rare. The acquired stenoses are normally divided into 4 groups: posttraumatic, post-irradiation, post-inflammatory and iatrogenic. Among the iatrogenic group the most frequent stenoses are those consequent upon injury to the laryngeal, nerves. In order to make the right diagnosis and to determine the level, degree and form of stenoses, it is necessary to make some clinical examinations, the most important being endoscopy of the inferior respiratory tract and the radiography. Šercer and his disciples (who include the authors of this article) have distinguished 5 groups of acquired stenoses: a) Stenoses due to paralysis of both nn. recurrentes with the paramedian position of the vocal cords. This group also includes cases with bad results following lateropexy of the arytenoids and vocal cords or cases of ankylosis of the cricoarytenoid joint. b) Stenoses due to scars within the laryngeal structures. c) Complete atresia of the larynx with obliteration of its lumen at a height of 10–15 mm but with preservation of the laryngeal skeleton. d) Cases in which the laryngeal skeleton has disappeared and the lumen of the larynx is represented by a slit lined by mucosa. e) Very severe cases where both the skeleton and the mucosa are missing and replaced by scars. The authors pay special attention to the stenoses which are a consequence of the paralysis of both recurrent laryngeal nerves and of the paramedian position of the vocal cords, and give a historical review and description of the most popular endolaryngeal and extralaryngeal operations, combinations of these two operative methods, and their modifications. In stenoses due to endolaryngeal scars with preservation of the laryngeal skeleton, the authors use submucous exenteration of the larynx by the method of Šercer. They describe the technique of this operation which gives very good respiratory results, although phonation is inhibited due to the loss of vocal and ventricular muscles. In the most severe group of stenoses, with obliteration of the laryngeal lumen and loss of the laryngeal skeleton, a new lumen of the larynx must to built up by a long and difficult decanulement. The authors devote a special chapter to analysis of the voice after submucous exenteration of the larynx by Šercer's method and in cases of reconstruction of the laryngeal lumen after partial resections. Finally, the authors present their results and compare the various methods of treatment of laryngeal stenoses. The reconstruction of the larynx is a complex problem because it must take account of both laryngeal functions: respiration and phonation; however, respiration is the primary laryngeal function while phonation is secondary.
Type of Medium:
Electronic Resource
URL:
http://dx.doi.org/10.1007/BF00373232
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