supraglottic laryngopharyngoplasty

Treatment of diseases: congenital subglottic stenosis Indication 1. The glottis is narrowed or the glottic stenosis is combined. 2. The throat is narrow and narrow. 3, laryngeal stenosis combined with narrow esophageal entrance. Contraindications Under the glottis, the trachea is narrow. 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. 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 There are oblique cuts and U-shaped cuts. The oblique incision is used for the pharyngeal approach and the U-shaped incision is used for the pharyngeal approach. (1) oblique incision: along the anterior border of the sternocleidomastoid muscle, the upper edge of the hyoid bone, down to the lower edge of the annular cartilage obliquely cut the skin, subcutaneous tissue and platysma. (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, into the throat and throat Divided into pharyngeal advancement and pharyngeal approach. (1) pharyngeal advancement: 1 reveal thyroid cartilage: after the U-shaped skin is cut, the skin and subcutaneous tissue are separated upwards to the hyoid bone. Transversely cut the sternohyoid muscle and the thyroid gland muscle to separate up and down, revealing thyroid cartilage, hyoid bone and lingual fascia. If necessary, cut the hyoid bone from the center. 2 reveal the throat and throat cavity: from the thyroid tongue periosteum transversely cut, separate the epiglottic anterior space, enter the epiglottic valley, and then expand into the pharyngeal cavity to the both sides of the lower edge of the hyoid bone. The upper thyroid artery is ligated and cut off, taking care not to damage the superior laryngeal nerve. For the convenience of operation, a horizontal incision was made in the middle of the ring membrane, and the thyroid cartilage was cut from the midline by heavy shearing, and the periosteum of the thyroid was expanded by an automatic retractor to reveal the laryngeal and pharyngeal lesions. (2) pharyngeal approach: 1 reveal thyroid cartilage: after the skin is obliquely cut, the skin, subcutaneous tissue and platysma are separated. The sternocleidomastoid muscle was pulled backward, and the lateral band muscle was cut from the upper edge of the thyroid cartilage, and the thyroid cartilage plate was exposed. 2 Excision of the thyroid cartilage plate: the upper thyroid cartilage was cut off. The inferior vagina muscle attached to the posterior edge of the thyroid cartilage plate was cut from the subchondral tissue, and the posterior edge of the thyroid cartilage plate was exposed backward. The chondral cartilage was separated from the thyroid cartilage on the superior and posterior edges of the thyroid cartilage, and most of the thyroid cartilage plate was exposed. From the lower thyroid cartilage angle up to the thyroid cartilage notch, the posterior upper part of the thyroid cartilage plate was removed. 3 After the thyroid cartilage plate was removed, the medial thyroid cartilage membrane and the laryngeal and lateral wall mucosa were cut with a knife and entered the throat and throat. The lesions in the throat and throat were clearly visible. 3, processing throat and throat lesions There are two ways to do this: (1) Separation of epiglottis adhesion: the epiglottis adhesion to the posterior wall of the pharynx is carefully cut, and then the perichondrium on both sides of the wound is slightly separated, and the periorbital pericardium is sutured with a 4-0 gut, such as The perichondrium is not enough, the tension is large, and the free cartilage can be repaired, so that the perichondrug is tightly sutured and the epiglottis is eliminated. The epiglottis rupture can cut the anterior wall mucosa of the shank longitudinally and separate, and the ankle stalk is removed from the subchondral membrane, and the perichonal membrane on both sides of the stalk is sutured. The posterior pharyngeal wall can be sutured by the mucosa of the nearby tissue. If the wound is large, it can be transplanted with oral mucosa or free skin. (2) epiglottis resection: If the epiglottis and the ventricular band are tightly attached and difficult to separate, the ventricular band can be removed together with the epiglottis, the epiglottis and the glottic scar, and the cartilage should not be damaged. 4, suture wounds The free piriform fossa and the mucosa of the epiglottis and the mucosa of the laryngeal cavity were used to repair the wound with sutures. 5, feeding the feeding tube and supporter A nasogastric tube is inserted from the nasal cavity. If the vocal cords on both sides are normal, the anterior joint zone between the thyroid cartilage plates is placed in the front joint support. If the scar on the glottis and throat is severe, the silicone rubber T-tube can be placed. The length of the T-shaped tube depends on the narrowing range of the scar, and it is generally required that the T-shaped tube exceeds the scar narrow area by about 1 cm. 6, suture incision (1) pharyngeal advancement: suture the hyoid bone and the base of the tongue with 3-0 gut suture, suture the periosteum of the thyroid gland, thyroid cartilage, suture the supraspinatus muscle and the anterior cervical band muscle, flush the incision, and release the stratification Suture the subcutaneous tissue and skin. (2) pharyngeal approach: suture the medial thyroid cartilage membrane and the laryngeal and lateral wall mucosa with the intestine, suture the lateral thyroid cartilage membrane and the thyroid periosteum, suture the band muscle, flush the wound, release the flow strip, and stratify Suture the subcutaneous tissue and skin. 7, take the support The anterior laryngeal joint support was incision from the original incision approach 4 to 6 weeks after surgery, and the support was taken out. For example, the silicone rubber T-tube is used, and the indwelling time is determined according to the degree of scarring on the glottis and the throat and throat. Generally, it can be placed for 3 months to 1 year. Remove from the tracheostomy opening. After taking out, put the tracheal tube and block the tracheal tube for 2 to 4 weeks. After breathing normally, remove the tracheal tube and repair the tracheal fistula.