anterior combined laryngoplasty

Treatment of diseases: pharyngeal scar stenosis congenital throat Indication Anterior combined laryngealplasty is suitable for: 1. Scarring of the anterior junction of the larynx. 2. Throat. Contraindications The neck infection has not healed. Preoperative preparation 1. Learn more about the condition and conduct a comprehensive physical examination, including heart, lung, liver and kidney function tests. 2. Indirect laryngoscope, direct laryngoscope and fiber bronchoscopy to understand the location, extent and extent of scarring in the larynx. 3. Take a positive X-ray or CT scan of the larynx to understand the location, extent, and extent of the stenosis. 4. Tracheotomy is generally a tracheotomy for chronic laryngeal stenosis. If not, a lower tracheotomy can be performed first, followed by an angioplasty. If the tracheotomy position is high, the cut opening should be moved to the 4th to 5th tracheal rings first. 5. Tracheal endocrine culture and bacterial drug sensitivity test. 6. Prepare the skin in the neck. Oral rinse with a 1:1000 nitrofurazone solution. 7. Prepare, fasting, and injecting atropine before general anesthesia. 8. Do a good job of explaining the work, so that patients can understand the treatment of scar stenosis is difficult, complications may occur, the quality of the sound is not good, and surgery may be necessary. Surgical procedure 1. The slit is divided into a straight slit and a U-shaped slit: (1) Straight incision: In the middle of the neck, the lower edge of the hyoid bone is raised, and the upper sternal notch is 1 to 2 cm. The skin, subcutaneous tissue and platysma are vertically cut, and the skin is separated to both sides. (2) U-shaped incision: 2 cm from the upper sternal notch to make a U-shaped incision, both sides to the inner edge of the sternocleidomastoid, thyroid cartilage plane, incision of the skin, subcutaneous tissue to the platysma, from the platysma Separate the hyoid bone, cover the platysma with a sterile cotton pad, suture a few needles outside, and then attach it to the hyoid bone with the platysma. 2. The thyroid cartilage is exposed to the skin and the subcutaneous tissue is retracted to the two sides, and the anterior cervical band muscle is exposed. The anterior and posterior ligaments are separated vertically from the center of the ligament to the laryngotracheal tube, and the thyroid cartilage is revealed by pulling the band muscle with a hook. Ring cartilage. 3. Cut the thyroid cartilage from the middle of the ring membrane to make a 3cm horizontal incision into the larynx. A 1% tetracaine gauze was placed from the incision to fill the upper end of the anesthesia cannula to prevent blood and saliva from flowing into the trachea, and the other end of the gauze was left outside the trachea. The thyroid cartilage plate was cut from the center of the thyroid cartilage from the incision or the knife. Note that the incision should be between the vocal cords on both sides, do not damage the vocal cords Adult thyroid cartilage is often ossified, difficult to cut with a knife or a knife, and the thyroid cartilage can be sawed with a bone saw. 4. Before the resection of the joint area, the thyroid cartilage plate was opened to the sides with an automatic retractor. The scar or sputum in the joint area before resection was performed, and the marginal margin mucosa was sutured by the gut. 5. Place the front joint supporter to clamp the prepared sputum support or umbrella silicone rubber support between the front joint and the thyroid cartilage board, and use the nylon thread to insert the needle from the one side of the outer throat silicone sheet and the thyroid cartilage board. Into the larynx, the silicone piece passing through the anterior union area crosses into the contralateral thyroid cartilage plate and is outwardly pierced to make an "8" suture, and the silicone () support is firmly fixed between the anterior joint and the flank of the thyroid cartilage. . 6. Stitch the thyroid cartilage and the incision. All the gauze in the trachea will be taken out, and the blood in the larynx lumen will be sucked out. The circumcision incision and the thyroid cartilage were sutured intermittently with a 4-0 gut. When suturing, pay attention to aligning the thyroid cartilage plates on both sides. The ribbon muscle, platysma, subcutaneous tissue and skin were sutured with a thin thread. Aseptic dressing is applied. 7. Pull out the anesthesia cannula and place the tracheal cannula. 8. Remove the support from the original skin incision 4 to 6 weeks after surgery, separate the pre-neck tissue until the support is exposed, cut the suture, remove the support, and use the gut to place the thyroid cartilage and the anterior cervical band muscle. Stitching. The subcutaneous tissue and skin were layered and sutured with silk thread, and the laryngoscopy was performed in parallel. 9. Remove the tracheal cannula, close the tracheal fistula to the supporter, block the tracheal cannula, observe for 3 to 4 weeks, after normal breathing, remove the tracheal cannula, and perform tracheotomy and open mouth repair and suture. complication 1. Patients with dyspnea and laryngotracheal angioplasty may have difficulty breathing after surgery. The reasons are: The laryngeal support is not fixed, and the support is detached under the tracheal cannula to block the respiratory tract. Before the support is detached, the fixed wire is usually broken and detached. When the patient finds that the fixed wire falls off and the supporter is active, he should immediately tell the doctor to take it out in time. 2. Incision hemorrhage repeatedly sucked out blood after sucking, indicating that there is bleeding in the incision in the laryngotracheal tube. Common bleeding sites are blood loss during the operation of the incision mucosa or muscles to stop bleeding. The incision should be opened to find the bleeding point to stop bleeding. 3. Subcutaneous emphysema, laryngotracheal fistula, open incision, suture, puncture, poor airway or severe postoperative cough can cause subcutaneous emphysema. In the case of subcutaneous emphysema, it is advisable to remove the suture of the neck skin and make the respiratory tract unobstructed and give antitussives. 4. In the laryngotracheal granuloma, laryngotracheal tube formation can sometimes grow granulation at the suture. The top of the support is not smooth and can also wear out to grow granulation. Large granulation can block the respiratory tract and form new scar stenosis. Generally, the laryngoscope, bronchoscope or fiberoptic bronchoscopy should be performed after the support is removed. If granulation is found, it can be bitten with a bite. 5. Laryngeal tracheal restenosis Severe laryngotracheal scar stenosis is often not successful in one operation, such as anastomotic stenosis, graft infection necrosis, absorption, rejection, or displacement; the respiratory tract formed by surgery is not large enough; Injury of the respiratory mucosa, the formation of new scar stenosis, etc. can be restenosis to make surgery failure. 6. Pulmonary infection Anesthesia intubation air bag leaks, there is no gauze around the intubation, blood flows into the lower respiratory tract, and there is no adequate suction after surgery, which can lead to pulmonary infection. During the operation, attention should be paid to prevent blood from flowing downward, soaking in time after surgery, dropping medicine in the trachea and applying antibiotics throughout the body.

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