[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.

[Residency is a fundamental stage of professional training of an otorhinolaryngologist]. / Ordinatura ­ osnovopolagayushchii etap professional'noi podgotovki otorinolaringologa.

Systematic analysis of various indicators of the educational process becomes important to assess the effectiveness of the training of residents. One of the most common tools for monitoring the effectiveness of the educational process is a questionnaire of students. OBJECTIVE: To analyze the results of the assessment of the quality of training in the residency of the Sverzhevky Research Clinical Institute of Otorhinolaryngology according to the survey of residents. MATERIAL AND METHODS: The study includes the results of an anonymous questionnaire survey of a sample group of residents of the residency of the Sverzhevky Research Clinical Institute of Otorhinolaryngology of the second year of study. RESULTS: The data obtained allow us to judge the satisfaction with the quality of training of the absolute majority of the interviewed residents, their active use of specialized electronic search engines, a high assessment of the level of lectures, the desire to improve their surgical training. The importance for the professional development of residents of participation in weekly scientific and clinical conferences of the Sverzhevky Research Clinical Institute of Otorhinolaryngology, meetings of the Moscow Scientific Society of Otorhinolaryngologists, traditional annual scientific and practical conferences of otorhinolaryngologists of Moscow, as well as in the activities of the Youth Council of the Institute is noted. CONCLUSION: The results of the survey create prerequisites for improving the educational process, the formation of professional competencies and readiness for independent work among residents.

[Chronic respiratory failure correction in cicatricial laryngeal and tracheal stenosis using helium-oxygen mixture]. / Korrektsiya khronicheskoi dykhatel'noi nedostatochnosti pri rubtsovykh stenozakh gortani i sheinogo otdela trakhei s ispol'zovaniem gelii-kislorodnoi smesi.

The article provides a review of the literature on the development of chronic respiratory failure in patients with chronic cicatricial stenosis of the larynx and cervical trachea. The authors provide data on the etiology, pathogenetic features of the course of cicatricial stenosis of the larynx and trachea, the reasons for the development of chronic respiratory failure, the effect of hypoxemia on general metabolic processes in the body and on regeneration processes, as well as on methods of their correction and improvement of the postoperative period. The methods of respiratory impact on chronic respiratory failure in these patients are considered, based on the experience of a number of researchers and technical advances in recent years.

[Implantation materials in reconstructive surgery of the larynx and trachea]. / Implantatsionnye materialy v rekonstruktivnoi khirurgii gortani i trakhei.

The article presents a literature review, that analyzes the use of implantation materials in reconstructive plastic surgery of the larynx and trachea in patients with local and extended laryngeal-tracheal stenosis, including lumen obliteration. 48 literature sources were studied. The positive and negative aspects of biological and synthetic implant materials use have been determined. The choice of an implantation material that meets all the demands for the complete restoration of the respiratory tract determines the relevance of the problem raised.

[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.

[Modern methods of the prevention and treatment of complications in reconstructive surgery in patients with stenosis of the larynx and trachea]. / Sovremennye metody profilaktiki i terapii oslozhnenii pri rekonstruktivnoi khirurgii u patsientov so stenozom gortani i trakhei.

The article provides a literarute review about the reconstructive surgery complications in patients with the larynx and trachea stenosis. The authors provide data on the etiology, pathogenetic features of the course of the larynx and trachea chronic stenosis, risk factors of the postoperative complication, and their prevention and therapy. Considered the methods of physiotherapeutic and pharmacological effects on the chronic inflammatory process in these patients and the experience of a number of researchers and the technical achievements of recent years.

[Diaphanoscopy palatal tonsils with use of the diode laser]. / Diafanoskopiia nebnykh mindalin s primeneniem diodnogo lazera.

For the purpose of decrease in intraoperative blood loss during a tonsillectomy the technique of a laser diaphanoscopy (DS) of the palatal tonsil (PT) and paratonsil space is developed. In the conditions of a transillumination of tissues of throat vessels paratonsil space which are preventively coagulated by the holmium laser are visualized. In carrying out DS of structures of a throat the 'pilot' red laser of the surgical laser LUMENIS Versa Pulse Power Suite 20W system was used. In a research there were 60 patients with chronic tonsillitis. Laser DS was carried out before tonsillectomy, at the same time 120 PT were subjected to raying. As result of the conducted research established that 60% of PT (n=72) anatomic were deeply shipped in a sidewall of a throat, 44,2% of PT (n=53) - had the expressed top pole, 0,8% of PT (n=1) - an additional segment. Also it was established that laser transillumination of paratonsil space is possible in the conditions of infiltration of fabrics isotonic physiological NaCl solution of 0,9%. Carrying out preventive coagulation of vessels of paratonsil space of Ho:YAG laser in the conditions of DS allows to reduce the volume of intraoperative blood loss to 4,17±0,37 ml that is 10,1 time less in comparison with the tonsillectomy which is carried out on traditional techniques.

[Surgical interventions on the pharynx in the structure of otorhinolaryngological care to the population of the city of Moscow]. / Khirurgicheskie vmeshatel'stva na glotke v strukture otorinolaringologicheskoi pomoshchi naseleniiu Moskvy.

The authors studied the reporting documentation of otorhinolaryngological hospitals of the city of Moscow on the surgical treatment of pharyngeal pathology in adults from 2002 to 2017. It was found that for 16 years surgical treatment of 290 362 patients with ENT-diseases was performed: 181.206 (62.4%) patients with diseases of the nose and paranasal sinuses, 24.981 (8.6%) patients with ear pathology, 60.346 (20.8%) patients with diseases of the pharynx and 23.829 (8.2%) - with diseases of the larynx. The assessment of the overall dynamics of the studied indicators was carried out on the 'trend lines'. For the considered period, the number of patients with surgical pathology of the pharynx increased by 33.2%. The proportion of tonsillectomies increased by 1.85 times to 56.5%, drainage of peritonsillar abscesses and abscesses-tonsillectomies decreased by 19%, uvulopalatoplastic increased 4.1 times, removal of neoplasms of the pharynx increased 2.2 times, adenotomies decreased by 2.4 times. Analysis of the data allowed to establish that, against the background of an ever-increasing number of surgical interventions for diseases of the pharynx in adults, a descending trend was noted only in the treatment of complicated forms of chronic tonsillitis and hypertrophy of the pharyngeal tonsil.

[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 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 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 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.

[About certain medical errors in the practical work of the otorhinolaryngologist].

The results of analysis of the most widespread medical errors made when providing emergency and routine medical aid to the subjects suffering respiratory distress are presented. The authors propose their own approaches to the prevention of such errors in the hope that this experience will be helpful for practicing otorhinolaryngologists in the choice of adequate treatment strategies and will promote professional advancement of young specialists.

[The causes of the development of cicatrical stenosis of the larynx and trachea in the patients presenting with Guillain-Barré syndrome].

The problem of rehabilitation of the patients presenting with post-intubation stenosis of the larynx and trachea remains unresolved despite the development of new methods for the diagnostics and treatment of this condition. One of the indications for long-term artificial lung ventilation is the severe form of Guillaine-Barret syndrome associated with paralysis of breathing muscles, development of bulbar symptoms, and disturbances of trophic process in the skin and mucous membranes. However, prolonged (mean 26 days) artificial lung ventilation may result in the formation of many-layer stenosis of the larynx and trachea whereas disturbed trophic processes in the skin and mucous membranes coupled to inadequate innervation complicate the postoperative conditions of the patients and promote restenosis of the tracheal lumen.

[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.

[Experimental model for the evaluation of the method and regimen of inhalation therapy].

An experimental model of upper respiratory passages has been developed to be used for the choice of parameters of inhalation therapy for inflammatory processes in the larynx and evaluation of its efficiency. The model was employed to characterize "inhalation accessibility" of different segments of the upper respiratory passages and to determine the amount of a medicinal product to be delivered to the affected zone per unit time. Optimal parameters of the inhalation procedure have been derived.

[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.

[Use of biomaterial alloplant and homeostatic material surgicel in reconstructive laryngeal and tracheal surgery].

Posttraumatic stenosis of the larynx, cervical and upper choracic parts of the trachea was treated surgically using biomaterial (cartilage) alloplant and hemostatic material sergisel with an antibacterial effect. Cartilage implantation into the lateral tracheal walls was made in 10 patients, creation of the lateral and anterial walls of the larynx and trachea was made in 4 patients. Short before the cartilage placing in the tissues it was packed with material sergisel. Further adequate dilatation prosthetic reconstruction of the trachea for 3-4 months with application of silicon T-tube allowed complete decanulation of 7 patients (50%) -- they have undergone plastic surgery of the anterior tracheal wall. The rest 7 patients are at the stage of dilatation of the tracheal passage with a good response to therapy. Thus, a positive treatment result of alloplant and sergisel (implant and hemostatic materials, respectively) allows us to recommend these materials for reconstructive surgery of hollow organs of the neck.