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We describe a case in which a repeat minitracheotomy (MT) could not be performed 2 months after the first. The cricothyroid membrane seemed calcified and histological examination showed scar formation with dystrophic calcification and heterotopic bone formation. Scar formation following MT may have caused these alterations making repeat access to the airway through the membrane impossible.
Surgical entry into the upper airway is not only important in emergency situations but also in the treatment of certain elective maxillofacial procedures. The procedure of choice by which surgical access is gained has traditionally been a tracheostomy. Although a cricothyroidostomy is easier and quicker to perform, with a higher degree of safety, it has generally been relegated to only emergency situations. The purpose of this paper is to present the anatomy, indications, and surgical technique of cricothyroidostomy. It is concluded that cricothyroidostomy, and not tracheostomy, is the preferred procedure for surgical establishment of an upper airway, either in elective maxillofacial surgical procedures, or in an emergency situation.
In young rabbits the growth of the subglottis was studied over a period of 20 weeks following an endolaryngeal trauma. This lesion of the larynx at the age of 4 weeks resulted in the development of a stenosis in the adult stage. The stenosis appeared to be caused by a specific change in the pattern of growth leading up to an anterior narrowing ('pear'-like) of the cricoid ring and a conspicuous thickening of the subepithelial layer.
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Tracheostomy and prolonged intubation are traditionally used in maintaining the airway, particularly after extensive maxillofacial surgery. The literature reports significant morbidity and mortality from both these procedures. Cricothyroidotomy is proposed as a useful alternative in certain circumstances. Recent documentation suggests that traditional fears of subglottic stenosis after cricothyroidotomy are ill-founded. Cricothyroidotomy may also benefit the patient by quicker rehabilitation and in early mobilisation, compared with prolonged intubation. The surgical procedure is quick and easily performed, making it suitable for emergency airway control. Cricothyroidotomy is not appropriate in children or in patients with inflammation to the trachea, since these may predispose to subglottic stenosis.
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Surgical treatment of bilateral abductor paralysis of the vocal cords is still a question for debate, as can be seen by a review of the relevant literature. The authors describe their modification of Thornell's technique, as used in 12 cases of recurrent paralysis, and they suggest a variant to the basic method which has been proved to cause minimal trauma, is simple to carry out and has produced excellent results.
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The present work is an attempt to add some refinement to the technique of vocal cord laterlization developed by Woodman for the management of bilateral abductor paralysis. The operating microscope is used together with some instruments designed for this operation. The technique follows the same principles introduced by Woodman, with few modifications. The use of the microscope makes dissection more delicate and less traumatic. The mucosa is seldom perforated and haematoma does not collect. These two factors help minimize the chance of wound infection. The lateralizing suture is introduced by a special needle and in the proper position under magnified vision ensuring perfect lateralization of the cord without puncturing the mucosa. The post-operative period is short, the patient is extubated earlier and the cost of treatment less than with the traditional technique. As far as voice is concerned, the results of both techniques are more or less similar.
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The laryngotracheal airway is the bottleneck of the respiratory system. Whereas disease in the nose or in the bronchial airways will affect respiratory airflow in a limited way, laryngotracheal disease must always be considered potentially life threatening. The nasal airway is the normal access to the lungs. As such, it serves vital functions in modifying the condition of ambient air before its access to the lungs. Impairment of the efficacy of nasal function in that regard will inevitably cast an unaccustomed burden on the lower airways and may possibly play a role in the long-term development of small airway disease in the lungs. When the nose is bypassed, acutely, as in orotracheal intubation, or chronically, as in tracheostomy or the laryngectomee, the pulmonary airways inevitably suffer. Attempts to substitute for the nose by humidification of inspired air are essential, but our current methods are not free of hazard and are of questionable efficacy. A better understanding of upper airway function and the injury resulting from malfunction or conducting ambient air directly to the trachea is now within our grasp but is not yet fully realized.
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An attempt was made to promote the growth of new cartilage from a frlage. Three dogs had the perichondrial grafting alone, while two had both the perichondrial grafting and a full thickness buccal mucosal graft. In all these dogs new cartilage was found as early as four weeks postoperative.