larynx Hondroperihondrit - one of the upper respiratory tract the most severe diseases caused by infectious diseases, when pyogenic flora enters the perichondrium.There are several forms of the disease, the most common of them - limited.In case of insufficient treatment hondroperihondrita disease takes an acute form, and can then flow into the chronic stage.
factors for laryngeal hondroperihondrita
Primary perihondrity develop by hematogenous in various infectious diseases (measles, influenza and so on. D.).The secondary may include those forms of the disease, when the first shell is affected mucosa of the larynx, and then - with the perichondrium cartilage.This occurs in syphilis, tuberculosis, cancer, and more often at various injuries (gunshot wounds, in contact with foreign bodies, intubation or tracheotomy with damage to the cricoid cartilage, and so on. D.).There are also radiation hondroperihondrity that develop during or after radiation therapy of malignant tumors of the larynx, as well as to
Hondroperihondrity divided into limited and spills, acute and chronic.Also there is a very conventional division into outer and inner depending upon where pathological process development prevails - on the outer or inner surface of perichondrium and cartilage.Most often affects both layers perichondrium.
observed small cell infiltration and serous impregnation perichondrium, which causes thickening of her, and then leads to fester with peeling perichondrium.Stripped of the power absorbed or necrotic cartilage, forming a fistula to stand out through their sequestration.Quite often, especially in traumatic forms hondroperihondritov around necrotic cartilage both leaflets sekvestralnoy perichondrium form the capsule wall.When
productive changes prevail over alterative that happens very rarely, the process becomes longer sclerosing character, in which the formed granulation infiltration and their subsequent scarring.When an hondroperihondrit purulent, necrotic and purulent decay prone hyaline cartilage of the larynx, which have their own vessels.Only cartilage epiglottis has its own vessels in the outer layer, which prevents it from necrosis with festering.It breaks down by type of progressive ulceration.
Gunshot hondroperihondrity occur originally.In this form of the disease most often affects the thyroid cartilage.Pretty rare while there is a pronounced respiratory failure.It may also be absent tendency to spread festering since the abscess quickly emptied through the wound channel.
symptoms and clinical hondroperihondrita larynx
Clinic hondroperihondrita larynx (complex of clinical symptoms) expressed by chills, fever, pain when swallowing, cough, hoarseness.Shortness of breath with extensive trauma or laryngeal TB first development is often explained by the basic process, but the real cause of these symptoms is installed later.When hondroperihondrity primary, they are identified immediately.Sometimes there is a smoothing of the contours of the larynx, the cartilage thickening and occurrence of severe pain on palpation, a slight increase in the volume of neck and cervical lymphadenitis.The most common lesion set during laryngoscopy.
Local symptoms hondroperihondrita larynx depend on the place of defeat.If involved cricoid, lightweight neck swelling is observed only when the outer ring of its defeat, it is because the other part of it covered by the thyroid cartilage.The inner perichondrium manifested swelling and locking of the vocal cords to close to the middle position.When there is an external perichondrium side of the ring, is noticeable swelling, which stands in the pyriform sinus.With the defeat of the plate cricoid cartilage of the larynx posterior wall bulges in podskladochnuyu area.The defeat of the cricoid cartilage is very often accompanied by asphyxia due to the development of stenosis podskladochnoy area, large sequester cartilage or aspiration of pus.
If amazed arytenoid cartilage, it is noticeable swelling, extending to cherpalonadgortannuyu fold, and pear-shaped sinus.The corresponding half of the larynx is stationary, vocal fold fixed in middle position.The pain associated with swallowing, combined with voice and breathing disorder that manifests with dyspnea and stridor can lead to asphyxiation.
When perichondrium of the thyroid cartilage exterior changes include a sharp pain when pressing on the neck in the area of the larynx.Laryngoscope visible swelling of the side wall that is located above the fold predtsvernoy and predtsvernoy and vocal folds, epiglottis legs, and sometimes cherpalonadgortannoy folds.In rare cases, there swelling in the piriform sinus and limited mobility corresponding half of the larynx.Most often, pus breaks in the anterior commissure.
When isolated lesions of the thyroid cartilage severe narrowing of the larynx, as a rule, is not observed.
If the disease is passed at a later stage, when all localizations laryngoscopy shows a fistula with pus or granulation, sometimes naked cartilage and sequestration.When there is a heavy perichondrium of the cricoid and arytenoid cartilage, the patient is forced anteriorly tilts his head.
When perichondrium observed swelling of the epiglottis its surface, much less - and even lingual, choke, stiffness and pain on swallowing.
Hondroperihondrit larynx sometimes complicated by an abscess or gangrene of the lung, aspiration pneumonia, pyosepticemia, purulent mediastinitis, zatechnoy cervical phlegmon, asphyxia.
By late complications of the disease include persistent scar stenosis of the larynx.
Therapeutic treatment of larynx hondroperihondrita
the treatment of laryngeal hondroperihondrita conduct basic disease therapy, eliminate the causes of traumatic hondroperihondrita.Showed antibiotics in combination with sulfonamides.At the same time must be conducted antidisfagicheskie events - patients swallowing pieces of ice, if there is severe pain, are appointed by inhalation or lubrication of the larynx dikainom.The good effect renders intranasal novocaine blockade.The patient was given pasty semi-liquid food.If there is a very sharp dysphagia, appointed nutrient enema.We do not recommend the introduction of a gastric probe, since it will be a constant irritant.When there is an inner perichondrium, to prevent the development of asphyxia, prescribe decongestants, and if increases stenosis of the larynx, producing a tracheotomy.If there is limited abscess, reveal his guttural endolaryngeal knife, so you can remove and sequester lying freely.If such interventions are not effective, surgery is performed outside: resection of the thyroid cartilage with submucosal dissection abscess, without, dissection or splitting of the larynx, with curettage of granulation and fistula or a wide submucosal dissection of the affected cartilage.If there are indications to the opening of the larynx, it is desirable to impose laryngotracheitis, t. E. Cut throat and upper rings of the trachea with suturing the skin of the mucous membrane.At the same time appointed restorative treatment, as well as glucocorticoid therapy for the prevention of re-scarring.Shown physiotherapy (ultraviolet irradiation, electrophoresis with potassium iodide), sessions with a speech therapist, and so on. D. Then, after the elimination of the stenosis and inflammation laringostoma closed plastic.
Radical surgical treatment of this disease is not always necessary.If inflammation of the small pockets and well limited, hondroperihondrit permissible to treat conservative or conservative surgery.