costal cartilage graft laryngotracheoplasty

Treatment of diseases: laryngotracheal scarring stenosis Indication Costal cartilage grafting for tracheal tracheal angioplasty is indicated for severe laryngotracheal stenosis. 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, extent and cartilage defect of the scar in the laryngotracheal tube. 3. Take the X-ray or CT scan of the lateral position of the larynx to understand the location, extent, extent and cartilage defect of the scar. 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 on the neck and chest. 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, postoperative swallowing, and may require surgery. Surgical procedure Rib cartilage A section of rib cartilage with a 3 to 4 cm cartilage was cut out in the 6th or 7th costal cartilage area, and was cut into a shuttle shape for use. Laryngeal tracheal incision Straight and U-shaped incisions: (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. 3. Separate the anterior jugular muscle to reveal the anterior wall of the larynx. 4. Under the guidance of the slotted probe, the thyroid cartilage, the ring cartilage and the tracheal ring were cut, the thyroid cartilage and the tracheal ring were retracted with an automatic retractor, and the scar tissue was removed under the mucosa. 5. Transplantation of the rib cartilage larynx in the tracheal cavity. The silicone T-tube trimmed according to the measured distance, if the narrow range is not large, the supporter may not be placed. Then the prepared costal cartilage is inserted into the laryngotracheal cavity with the costal cartilage membrane, and the costal cartilage is sutured with the thyroid cartilage plate, the annular cartilage and the tracheal cartilage with a 3-0 gut, suture It is necessary to penetrate the costal cartilage and the laryngotracheal cartilage. After the position of the costal cartilage is placed, the suture is ligated at the same time. 6. Suture the incision with the gut suture of the anterior cervical band muscle, wash the wound with saline, and place a rubber drainage strip. The filaments layer suture the platysma, subcutaneous tissue and skin. Aseptic dressing is applied. 7. Remove the supporter 1 to 3 months after surgery.