喉頭気管外傷の治療

Abstract

The surgical management of the tracheal stenosis is classified into two techniques.1)The trachea is opened and a polyethylene tube is inserted into the trachea after removal of the cicatricial tissue. The tube is then fixed with a nylon thread and the tracheal cavity is primarily closed. The tube is removed 12 months later. The patient can respirate, phonate and swallow without disturbance from the tube in the trachea.2) The trachea is opened and the raw area is covered with advanced pedicle skin flaps. The tracheal cavity is secondarily closed 3 to 6 months after surgery.In cases of subglottal stenosis, the c r icoid cartilage and the inferior part of thyroid cartilage are divided and the cicatricial tissue removed. A vinyl tube wrapped with a split free skin graft is inserted into the laryngeal cavity. A block of the thyroid ala is incised with the outer perichondrium connecting to the cricothyroid membrane and this block is rotated to fit between the cut edges of the cricoid cartilage. Then the subglottal space is closed and the tube is fixed in place with penetrating nylon threads through the skin. The tube is removed under microlaryngoscopy 5 weeks after surgery.There are three techniques in the tre a tment of the glottal stenosis.1) The thyroid cartilage is divided. A core mold wrapped with a split free skin graft is inserted into the laryngeal cavity after the cicatricial tissue is removed and the laryngeal cavity is primarily closed.2) After removal of the cicatricial tissue, cervical skin flaps are advanced to cover the raw area. The laryngeal cavity is secondarily closed.3) As for the glottal reconstruction after hemilaryngectomy for carcinoma, bilateral pedicle island flaps are advanced into the laryngeal cavity to cover the raw area. The laryngeal cavity is primarily closed.