retroglottic dehiscence cartilage transplantation

Treatment of diseases: congenital subglottic stenosis Indication Post-glottic open cartilage transplantation is suitable for posterior glottic stenosis or combined with subglottic tracheal stenosis. Preoperative preparation 1, a detailed understanding of the condition, a comprehensive physical examination, including heart, lung, liver, kidney function and other tests. 2, indirect laryngoscope, direct laryngoscope and fiber bronchoscopy, to understand the location, extent, extent and cartilage defects of scar stenosis 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: general chronic laryngeal stenosis has been tracheotomy, if not done, you can do low tracheal incision, and then undergo 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, neck preparation skin, such as preparation for taking costal cartilage, chest should be prepared skin. Oral rinse with a 1:1000 nitrofurazone solution. 7, according to general anesthesia preparation, fasting, injection of atropine. 8. Do a good job of explaining the work, so that it is difficult for patients to understand the treatment of scar stenosis. Complications, poor sound quality, postoperative swallowing, and reoperation may be necessary. Surgical procedure 1. Incision and exposure of thyroid cartilage (1) Incision: separate 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 sternal bone is cut 1 to 2 cm. The skin, subcutaneous tissue and platysma are vertically cut, and the skin is separated to both sides. 2U-shaped incision: 2cm from the upper sternal notch to make a U-shaped incision, both sides to the inner edge of the sternocleidomastoid muscle, the plane of the thyroid cartilage, cut the skin, subcutaneous tissue to the platysma, and separate the tongue from the platysma 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) revealing thyroid cartilage: after the skin and subcutaneous tissue are pulled to the sides, the anterior cervical band muscle is exposed, and the anterior and posterior ligaments are separated vertically from the center of the ligament to the laryngotracheal tube, and the ligament is revealed by pulling the band muscle with the hook. Cartilage and ring cartilage. 2, cut thyroid cartilage and tracheal ring The thyroid cartilage, the annular cartilage and the tracheal ring were cut under the guidance of the slotted probe, and the laryngeal tracheal cartilage was opened with a hook to reveal the scar of the laryngotracheal cavity. 3. Combined and annular cartilage plate after incision Use an orthopedic knife to incision from the posterior median section. The incision is extended downward to the middle of the annular cartilage plate. Be careful not to cut through the posterior wall esophagus of the annular cartilage plate. The annular cartilage plate was carefully separated to the sides with a small stripper, and 1% tetracaine adrenal gland adrenaline gauze was pressed to stop bleeding. 4, take the cartilage graft A piece of 3 mm × 4 mm size was taken from the thyroid cartilage plate with a piece of perichondrug cartilage. 5, transplanted cartilage The excised cartilage-bearing cartilage and the perichondrium are implanted into the ring of the annular cartilage plate toward the laryngotracheal cavity side, and the transplanted cartilage is sutured with the bilateral annular cartilage plate by the gut. 6, put the support and nasal feeding tube The supporter can be filled with an iodoform gauze strip or a foam sponge to form a finger sleeve support, or a silicone rubber T-shaped tube can be used as a support. The fingertip support should only be removed after 2 to 4 weeks. Place the nasogastric tube first, then place the prepared support into the larynx and tracheal cavity. The finger sleeve support is tied to the tracheal tube with a thick wire. 7, suture incision The thyroid cartilage, the ring cartilage and the tracheal ring were sutured intermittently with the gut, the anterior cervical band muscle was sutured, the incision was washed with saline, and the flow strip was placed. The platysma, subcutaneous tissue and skin are sutured with fine threads. Aseptic dressing is applied. 8, ligature fixing If the finger is used as a support, the operation is completed, the anesthesia cannula is taken out, the tracheal cannula is placed, and the ligature of the finger cuff is fixed on the tracheal cannula. 9, take out the support Use the fingertip as a support and take it out 2 to 3 weeks after surgery. If you use a silicone T-tube, you can take it out 1 to 3 months after surgery.