Acute and chronic stenosis of larynx and trachea

Stenosis of the larynx or trachea - narrowing of the larynx and / or trachea lumen, which disrupts the air flow into the respiratory tract and lungs. In terms of the stenosis are divided into acute, developing for a short time (up to 1 month), and chronic, forming slowly (more than 1 month).

[1], [2], [3], [4]

Epidemiology of acute and chronic stenosis of the larynx and trachea

In the practice of the otorhinolaryngologist, stenosis of the larynx and trachea is diagnosed often - 7.7% of the number of all diseases of the ear, throat and nose. The main cause of cicatricial stenosis of the larynx and trachea at the present time is prolonged artificial ventilation of the lungs. The incidence of cicatricial changes in the larynx and trachea during resuscitation accompanied by artificial ventilation is 0.2 to 25%, according to various authors. In 67% of patients with tracheostomy, tracheal injuries of various degrees are detected - from the formation of granuloma to cicatricial stenosis and tracheomalism. After surgical interventions on the neck, complications in the form of paralysis and paresis of the larynx are observed and 15% chance, most of them after a strumectomy. In 3-5% of patients, the central paralysis of the larynx develops after severe craniocerebral trauma, in 6-8% - the etiology is unclear.

Neck injuries are accompanied by an airway trauma in 7-10% of cases: the bowl is diagnosed with isolated tracheal injuries, less often the larynx and trachea simultaneously, which is much heavier. Untimely diagnosis and incorrect treatment tactics lead to the formation of a deformable airway in the process of healing with the development of cicatricial stenosis.

[5], [6], [7]

Causes of acute and chronic stenosis of the larynx and trachea

Among the etiological factors are the infectious-allergic, iatrogenic, neurogenic, traumatic, idiopathic, compression (compression of the larynx tracheal structures from the outside). The causes of acute stenosis of the larynx can be:

• acute inflammatory processes of the larynx or exacerbation of chronic (edematous, infiltrative, phlegmonous or abscessed laryngitis, exacerbation of chronic edema-polyposic laryngitis);
• mechanical, thermal and chemical trauma of the larynx;
• congenital pathology of the larynx;
• foreign body of the larynx;
• acute infectious diseases (diphtheria, scarlet fever, measles, typhus, malaria, etc.):
• an allergic reaction with the development of laryngeal edema;
• other diseases (tuberculosis, syphilis, systemic diseases).

Acute and chronic stenosis of larynx and trachea - Causes and pathogenesis

[8], [9], [10], [11], [12], [13], [14]

Symptoms of acute and chronic stenosis of the larynx and trachea

Regardless of the cause that causes acute stenosis, the clinical picture is the same. The pronounced negative pressure in the mediastinum with intense inspiration and hypoxia causes a characteristic symptom complex: a change in the rhythm of breathing, the occlusion of the supraclavicular pits and the entrainment of the intercostal spaces, the forced position of the patient with the head thrown back, the larynx of the larynx during inspiration and exhalation. The severity of clinical manifestations of acute and chronic stenosis depends on the nature of traumatic effects on the body, the degree of damage to the hollow organs of the neck, the extent of stenosis, the duration of its existence, individual sensitivity (resistance) to hypoxia, the general state of the body.

Classification of acute and chronic stenosis of the larynx and trachea

Stenoses of the larynx and trachea are classified according to the etiologic factor, duration of the disease, localization and degree of constriction. Chronic stenoses of the larynx and trachea are divided into paralytic, post-traumatic and post-intubation. The localization of stenosis relative to the vertical plane distinguish stenoses of the glottis, podogolosovogo space and tracheal: horizontal - anterior, posterior, circular and total stenosis. This requires careful identification of the site of narrowing and allows you to choose an appropriate treatment for a particular situation. In recent years, the percentage of prolonged stenoses of the larynx and trachea increases, when the area of narrowing captures several anatomical regions, the larynx, the cervical and thoracic parts of the trachea. When determining indications for various types of surgical treatment, stenoses are classified into two groups;

• limited laryngeal and laryngeal tracheal stenosis, characterized by a favorable course of the wound process without affecting the repair properties of tissues;
• a common laryngeal tracheal stenosis, characterized by an unfavorable course of the wound process with gross structural and functional damage.

[15], [16], [17], [18], [19]

Screening

Stenosis of the larynx and trachea is revealed by the nature of dyspnea and the presence of a stridor when examining the patient. An indication in an anamnesis of a trauma or surgery in the neck and chest or intubation will allow one to suspect the presence of stenosis of the upper respiratory tract.

Diagnosis of acute and chronic stenosis of the larynx and trachea

The examination of patients is carried out to assess the functional state of the respiratory organs, the degree and nature of the narrowing of the upper respiratory tract, the general state of the organism. When collecting anamnesis, attention should be paid to the duration and severity of symptoms of respiratory failure, its association with the etiologic factor (trauma, surgical intervention, intubation, the presence of acute infectious diseases).

Acute and chronic stenosis of the larynx and trachea - Diagnosis

[20], [21], [22],

Treatment of acute and chronic stenosis of the larynx and trachea

Methods of treatment of acute and chronic stenosis of the larynx and trachea are divided into conservative and surgical. Conservative methods of treatment are used in the detection of acute stenosis of moderate degree with unexpressed clinical manifestations; acute injury, not accompanied by significant damage to the mucosa; early post-ablation changes in the larynx and trachea without a tendency to progressive narrowing of their lumen. Also conservative management of patients with acute and chronic stenosis of I-II degree is allowed in the absence of severe clinical manifestations.

Acute and chronic stenosis of the larynx and trachea - Treatment

Prevention of acute and chronic stenosis of the larynx and trachea

Prevention of acute stenosis is the timely diagnosis and flow of inflammatory diseases of the upper respiratory tract, infectious diseases, general pathology.

Prevention of chronic stenosis of the larynx and trachea consists in observing the timing of tracheostomy to patients who are on prolonged artificial ventilation of the lungs, the use of modern tracheotomy cannulas, the timely implementation of reconstructive interventions for injuries to the hollow organs of the neck, prolonged follow-up of patients suffering from wounds of the hollow organs of the neck and surgical interference with them.

Forecast

The success of treatment of acute and chronic stenosis of the larynx and trachea depends on the timeliness of the patient's treatment for medical care, the qualification of medical personnel and the availability of a medical institution.

[23], [24], [25]