Surgical Restitution of Chronic Stenosis of the Larynx and Cervical Trachea

Abstract

The management of chronic stenosis of the larynx and cervical trachea is usually a difficult task for laryngological surgeons.The surgical treatment of the established late case of chronic laryngotracheal stenosis depends on the location and the nature of the obstruction. If the cartilaginous framework is not injured, a simple open operation can be adopted to remove cicatricial tissues, granuloma and/or polipi obliterating the airway lumen. The opening fistula is closed after an appropriate period of time when it is apparent that the lumen is well maintained.More extensive reconstruction of the stenosed larynx or tracheab ecomes necessary when the configuration of the suppooting cartilages is destroyed by trauma or infection and severe concentric obliteration of the lumen is evident. A wide excision of scar tissues followed by placement of a mucosal graft to cover the raw surface of the lumen is indicated. The graft is usually taken from the nasal septum or buccal wall and is supported in place with a silicone mould, which is also preventing the collapse or reobliteration of the airway lumen. Several devices are proposed for surgical closure of the large postoperative fistula in the anterior neck.It should be stressed that good cooperation between the patient and surgeons is mandatory during the course of long term treatment.