Surgical treatment of chronic laryngeal stenosis caused by trauma.

Abstract

Laryngeal stenosis caused by trauma has been increasing in number. In this paper, the auther presented 15 cases of the laryngeal stenosis and his three surgical methods were discussed. 1) Fistulization of air way on the cricoid arch. This operation was performed for the chronic laryngeal stenosis after fracture and injuly of the arch of cricoid cartilage following the car accident and reffered tracheotomy. Method. After removal of scar and necrotic cartilage, the skin was sutured to the mucosa to-to for fistula formation. The scar around the fistula had become stiff enough, then the fistula was closed with skin flap three week after the operation. 2) Widening of anterior glottal space. In stenosis with median fixation of the vocal cords, the auther applied this technique instead of the lateralization method. Method. Skin incision is made in midline over the thyroid cartilage and the perichondrium is elevated from cartilage lOmm width from the midline. The cartilage is separated longitudinally and the median portion of cartilage are resected 5 to 6mm in width bilaterally. The mucosa of the anterior wall of the glottis is separated in the midline. The edge of each side mucosa is sutured to the edge of the perichondrium and to the skin of same side. The created fistula is closed three weeks after the operation. The anterior part of the glottic space was wide-opened to get good respiratory results. 3) Operation method for the supraglottic stenosis. The removal of the necrotic thyroid and cricoid cartilages results in the reduce the oedema of air way though, another stenosis reveals, later. The loss of the cricoid cartilage as the posterior framework of air way causes the shortage of antero-posterior distance, especially in the ary-epiglotic space. Method. 2 to 3 skin flaps of the anterior neck are transposed and partially resected in order to make a short neck. Longitudinal shortning of the neck surface causes the widening of air way and scar tissue of the wound should be the framework around the air way. The fistula is closed after an appopriate period of time when it is apparent that the lumen is well maintained. The auther reported three cases treated with this method.