[The use of the dura mater at the final stage of reconstructive plastic surgical treatment of cicatricial stenosis of the larynx and trachea]. / Ispol'zovanie tverdoi mozgovoi obolochki pri zaklyuchitel'nom etape rekonstruktivno-plasticheskogo operativnogo lecheniya rubtsovogo stenoza gortani i trakhei.

The article presents an analysis of the plastic reconstructive surgery effectiveness for patients with an extended tracheal defect using an allograft based on the dura mater (DM) at the final stage of surgical treatment of laryngeal and tracheal cicatricial stenosis. The study included 20 patients with cicatricial stenosis of the larynx and trachea, who were previously performed plastic reconstructive treatment with scar tissue excision in the lumen of the respiratory tract and restoration of the supporting frame of the larynx and trachea using allografts based on costal allocartilage. The age of the patients ranged from 21 to 54 years, the duration of the disease was from 1 to 5 years. After a standard clinical and laboratory examination, with a mandatory video endoscopic examination of the larynx and trachea, multislice computed tomography of the larynx and trachea, patients underwent plastic closure of the tracheal defect using DM. Dynamic outpatient monitoring was carried out once a week for 1 month, once a month for 3 months, control examination was done 6 months after surgical treatment. The results of the study demonstrated a full-fledged social and labor rehabilitation of all 20 patients after the final stage of surgical treatment using DM, the absence of rejection reaction and migration of allo-implantation material, the preserved lumen of the larynx and trachea with a rigid supporting skeleton and the absence of anterior tracheal wall floatation. The use of DM as an additional strengthening of the anterior tracheal wall for patients with deficiency of muscular aponeurotic tissues and more than 2 cm size tracheal defect is highly effective at the final stage of surgical treatment for plastic closure of the tracheal defect.

[The use of platelet-rich plasma in the treatment of cicatricial stenosis of the larynx and cervical trachea]. / Primenenie obogashchennoi trombotsitami plazmy v lechenii rubtsovykh stenozov gortani i sheinogo otdela trakhei.

Despite the technical achievements of recent years in medicine, the problem of frequent recurrent stricture formation of the lumen of larynx and cervical trachea remains urgent. The etiology and pathogenesis of development of scar stenosis of the larynx and trachea were considered, and the analysis of the drugs' use for topical therapy in the comprehensive treatment of this pathology was conducted in the presented review. Special attention was paid to plasma enriched with platelets, its use in otorhinolaryngology, in particular in the treatment of laryngeal diseases. Positive and negative sides of the adjuvant therapy use have been identified. The search for means helping to prevent recurrent stricture formation of laryngeal lumen and cervical trachea determines the interest of the considered problem.

[To optimize the management of patients after tracheostomy and reconstructive operations on larynx and trachea]. / Optimizatsiya vedeniya bol'nykh posle trakheostomii i rekonstruktivnykh operatsii na gortani i trakhee.

The relevance of the study is due to the need to improve the methods of managing patients after reconstructive surgery on the larynx and trachea. OBJECTIVES: To optimize the management of wounds after tracheostomy and/or reconstuctive operations on larynx and trachea on the basis of use of modern dressings in the inpatient and outpatient settings. MATERIAL AND METHODS: The patients were divided into two: group I tracheostomy after reconstructive operations on the larynx and trachea. The postoperative area was ligated with drugs based on sodium alginate. Tracheostomy of group II patients was carried out according to the standard technique. RESULTS: In the first group of patients, postoperative wounds healed by primary intention on the 5-6th day after the operation in patients with bilateral paralysis of the larynx and on the 8-10th day in patients with chronic cicatricial stenosis of the larynx and trachea. In group II, postoperative wounds in the tracheostomy foramen area healed on day 7 in patients with bilateral paralysis of the larynx and on days 10-14 in patients with chronic cicatricial stenosis of the larynx and trachea. CONCLUSIONS: The Proposed algorithm for the management of patients after reconstructive operations on the larynx and trachea, of tracheostomy have improved clinical outcomes after surgery and to reduce the economic costs for this group of patients.

[The modern approach to the treatment of subglottic laryngeal stenosis]. / Sovremennyi podkhod k lecheniiu podskladkovogo stenoza gortani.

The objective of the present study was to optimize the treatment of patients with subglottic laryngeal stenosis. MATERIAL AND METHODS: We have examined a total of 14 patients presenting with subglottic laryngeal stenosis. The etiological factors and underlying conditions of laryngeal stenosis were the prolonged intubation in 4 patients, Wegener granulomatosis in 6 patients, and idiopathic stenosis of the larynx in 4 patients. All the patients underwent balloon dilatation with the application of the video endoscopic technique. RESULTS: The surgical treatment of all the patients made it possible to achieve the persistent expansion of the lumen of the subglottic part of the larynx, to shorten the periods of the in-patient treatment and rehabilitation of the patients. Restenosis of laryngeal lining stenting was observed in one patient presenting with Wegener's granulomatosis which was associated with the relapse of the underlying disease.

[The iatrogenic complications of tracheostomy]. / Iatrogennye oslozhneniia trakheostomii.

The objective of the present study was to analyze the complications of tracheostomy associated with bleeding from the brachiocephalic trunk. A total of 13 protocols of the autopsy study of the patients who had died in the intensive care unit were available for the analysis. These patients had experienced heavy external bleeding from the tracheostomy defect shortly before death. The study has demonstrated that all the victims had the tracheostomy hole localized below the level of the standard dissection of the tracheal rings. Nine patients presented with a damage to the brachiocephalic trunk while four others had a pressure injury to the blood vessels. The study included the elucidation of the possible relationship between the anthropometric characteristics of the patients and the variability of the passage of the brachiocephalic trunk in front of the trachea. The length of the neck was found to usually correlate with the length of the body and the brachiocephalic trunk to run in front of the trachea at the level of its 8th-11th rings. The results of the present study may be instrumental in reducing the risk of complications after tracheostomy.

[The diagnostics and treatment of bilateral paralysis of the larynx]. / Diagnostika i lechenie dvustoronnego paralicha gortani.

The objective of the present study was to consider the currently available methods for the diagnostics and treatment of the patients presenting with bilateral paralysis of the larynx of various etiologies. We undertook the analysis of the publications in the domestic and foreign scientific literature concerning diagnosis and treatment of bilateral paralysis of the larynx. It was found that despite the existing modern high-tech diagnostic technologies and the variety of surgical methods for the treatment of this condition, the problem of diagnostics, management, and rehabilitation of the patients suffering from bilateral paralysis of the larynx remains a serious challenge for the researchers and clinicians that requires further investigation of this pathology. For the correct and timely diagnosis of bilateral paralysis of the larynx, the comprehensive evaluation of the functional state of the neuromuscular apparatus of the larynx is necessary. The key prerequisites for the success of the surgical intervention are its timeliness and the choice of the optimal surgical modalities.

[The modern aspects of the treatment of the patients presenting with bilateral laryngeal paralysis depending on the duration of the disease]. / Sovremennye aspekty lecheniia bol'nykh dvustoronnim paralichom gortani v zavisimosti ot dlitel'nosti zabolevaniia.

AIM: the objective of the present study was to increase the functional effectiveness of the combined treatment of the patients presenting with bilateral laryngeal paralysis on the basis of the development of a medical diagnostic algorithm taking into consideration the peculiar etiological and pathogenic features of the clinical course of the disease. The study included 102 patients suffering from bilateral paralysis of the larynx. The duration of the disease varied from 2 months to 26 years. All the patients underwent the preoperative preparation followed by laryngoplasty surgery for unilateral myoaritenoidchordectomy. The patients who had no tracheostoma at admittance were treated by simultaneous tracheostomy and laryngoplasty. The study made it possible to identify the factors that exerted the adverse influence on the outcome of the operation, such as prolonged cannulation, a protracted course of the disease (for more than 1 year), longer periods of recovery of the external respiration function characteristics, increased duration of the hospitalization and rehabilitation periods that lasted over more than one year, and a rise in the number of the patients carrying the cannulas. Taken together, the proposed algorithm for the examination and treatment of the patients presenting with bilateral laryngeal paralysis, the early diagnostics of the disease, and the differential approach to its treatment made it possible to reduce the frequency of the immediate and long-term postoperative complication and decrease the duration of hospitalization and rehabilitation of the patients.

[The influence of the tracheal stents on the microbiocenoses of the larynx and trachea at different duration of the cannula-bearing period].

The objective of the present work was the microbiological analysis of laryngeal and tracheal mucosal swabs as well as the study of the contents of the tracheostomy tubes taken from the patients presenting with laryngeal and tracheal stenosis of different etiology. Both the in- and outpatients with different duration of the cannula-bearing period were involved. Special attention was given to the influence of the tracheal stents and the frequency of their cleaning on the microbiocenoses of the larynx and trachea. The study has demonstrated that the patients bearing cannulas are in need of everyday toilet of the tracheostomy tube and tracheostoma; also needed is the choice of the tubes with due regard for a the anatomical features along with general and local antibacterial therapy for reducing pathogenicity of microflora in the tracheobronchial tree and decreasing the frequency of postoperative complications.

[Treatment of patients with complicated tonsillogenic infection].

The number of patients with pyo-inflammatory complications associated with chronic tonsillitis has increased in the recent years. The objective of this paper was to analyse the frequency of stenotic conditions caused by purulent complications of tonsillogenic infection. An algorithm is proposed for diagnostic examination and treatment of patients with descending tonsillogenic infection suffering obstruction of the upper respiratory tract.

[Variants of tracheostomy depending on etiology of laryngeal and tracheal stenosis].

The results of tracheostomy and prevention of airway stenosis depend much on preoperative examination, adequate management of postoperative period. Introduction of the treatment algorithm including rational surgical approaches, wide-spectrum antibiotics, drugs improving tissue repair, local and general antihypoxic therapy significantly raises effectiveness of post-tracheostomy rehabilitation.

[Respiratory and metabolic disturbances in patients with laryngeal and tracheal stenosis of different etiology].

Development of hypoxic hypoxia in stenosis of the larynx and cervical trachea of different etiology leads to respiratory insufficiency and bioenergetic impairment. Investigation of blood gas composition and acid-base balance in patients with laryngeal and tracheal stenosis determines severity of respiratory insufficiency and metabolic disturbances. Parameters of gas composition and acid-base balance of arterial and venous blood are not similar in different etiological groups. The studies revealed pathognomonic signs of laryngeal and cervical trachea stenosis of different etiology.

[Rehabilitation of patients with bilateral laryngeal paralysis in a time aspect].

According to the literature, up to 15% surgical interventions on the neck is accompanied with such complications as paralysis and paresis of the larynx. Rehabilitation of paralysed larynx by staged surgical treatment and prosthesis lasts for years. Late diagnosis of bilateral laryngeal paralysis after cervical surgery entails persistent systemic poststenotic alterations. The authors offer the diagnosis-treatment algorithm for patients with bilateral laryngeal paralysis which allows a significant reduction in duration of rehabilitation.

[Therapeutic algorithm in stenosis of the larynx and cervical trachea of various etiology].

An algorithm of the treatment of laryngo- tracheal stenosis (LTS) is proposed to raise efficacy of surgical treatment of LTS and to reduce the number of postoperative complications. The algorithm comprises adequate preoperative preparation of the patients including pharmacological prophylaxis of inflammation in the operative zone; effective use of laryngotracheoplasty; prophylaxis of postoperative scarring including reconstruction of created laryngotracheal passage and administration of medicines influencing general and local immunity, tissue metabolism, repair in the region of postoperative inflammation. The efficacy of the algorithm was followed up un 54 (33.7%) patients with laryngostenosis and 106 (66.3%) patients with laryngo-tracheal stenosis. The algorithm application help rehabilitate all the patients with laryngeal stenosis and 92 (86.8%) patients with laryngo-tracheal stenosis.