Surgical treatment of chronic laryngeal stenosis secondary to vocal cord paralysis: pre and postoperative evaluation of ventilatory function.

Thirteen patients with chronic laryngeal stenosis were operated upon with total excision of stenotic scar tissue, enlargement of the lumen by sectioning the back and front wall of the larynx, and application of an indwelling Teflon prosthesis for 4 months. The stenosis was in many cases caused by long-standing recurrent paralysis complicated by attempted surgical correction of the stenosis. Following operation, the specific airway conductance increased in all patients (mean +/- SD pre and postoperative values 0.51 +/- 0.30 and 1.12 +/- 0.51 kPa-1.s-1, respectively). The FIV1/FVC ratio was determined in 9 patients and an increase was postoperatively noted in all of them (mean +/- SD pre and postoperative values 43 +/- 17 and 76 +/- 13%, respectively). The physiological findings confirmed the excellent clinical results of the treatment.

Inferior dacryocystorhinostomy in severe congenital dacryostenosis.

Inferior dacryocystorhinostomy is a simple and effective method in the treatment of such cases of congenital dacryostenosis in which conservative treatment and probing have failed and in which the atresia is located at the level of the nasolacrimal duct. The operative technique is described in detail. The series treated by this method consists of 8 patients, 3 of whom showed bilateral stenosis. On 2 patients adenoidectomy was performed in connection with the dacryocystorhinostomy. The follow-up time ranged from 2 to 34 months, and a good result was obtained in 7 cases. In one case the passage produced closed soon after the operation. Endonasal dacryocystorhinostomy was then successfully carried out by West's method. The operative technique described is well suited for patients under two years of age.

Long-term results after surgical treatment of laryngeal stenosis in small children.

Thirteen severe cases of laryngeal stenosis were operated on at the ages of 1-3 years. The operations were performed by making a laryngofissure in the front part of the larynx and excising the stenosing scar. The back wall of the larynx was incised in the midline and the two halves of the cricoid lamina were separated from each other. An indwelling prosthesis was placed in the larynx for 4 months. All patients but one were decannulated. The positive clinical result of the operation proved to be permanent through the rapid growth phase of puberty in 7 patients out of the 10 who had reached puberty. Three patients developed a gradually worsening laryngeal stenosis during the rapid growth phase of puberty. One of them was successfully re-operated. The mean follow-up time was 12 years. Ventilatory function tests were performed on 9 patients, 4 of which proved to have normal ventilatory function or only slight airflow limitation in central airways.

Laryngeal stenosis following papillomatosis--a report of three severe cases.

Three cases of severe laryngeal papillomatosis beginning in early childhood are presented. Several methods of treatment were tried, but lasting results were achieved by suction diathermy. The laryngeal lumen was totally obliterated in all cases during the course of the disease. The patients were successfully operated on by making a laryngofissure in the front part of the larynx, excising the scar and enlarging the lumen by a median incision in th back wall of the larynx. An indwelling prosthesis was placed in the larynx for several months. After removing the prosthesis, the laryngeal lumen was dilated several times by oesophageal sounds. All patients were successfully decannulated. The results of treatment are evaluated both clinically and by ventilatory function studies. Central airway obstruction persisted in two cases.

Wegener's granulomatosis in childhood. A clinical report based on 3 cases.

Wegener's granulomatosis is a very rare disease in children; only 10 cases have been reported in the literature. The present report describes 3 cases where Wegener's granulomatosis developed at an early stage, beginning with upper respiratory tract symptoms. All the 3 children have been successfully treated with a combination of azathioprine and corticosteroids.

Clinical and histological malignancy of adenoid cystic carcinoma.

The authors report on 25 cases of adenoid cystic carcinoma of the head and neck region. The tumours were divided into 4 histological malignancy groups. Treatment generally consisted of surgery performed with as large a margin as possible, in combination with split course million volt therapy, about 6,000 rads, usually given preoperatively. It was found that the patients in the groups of lower malignancy generally managed for a comparatively long time without a clinically demonstrable recurrence, while the patients in the groups of higher malignancy relapsed rather quickly and often had metastases. The patients in the groups of higher malignancy also died relatively soon after the histological tumour preparations.

Transantral orbital decompression in the treatment of Graves' disease.

A series of twenty patients operated on for severe endocrine exophthalmos is presented. All the operations were performed by removing the orbital floor, making a total ethmoidectomy and removing part of the inferior orbital margin; in some cases, a section of the lateral orbital wall was also removed. No serious complications were detected. In all but one patient there was an immediate, marked decrease in exophthalmometry. A marked decrease of the inflammatory signs of the conjunctivae was also observed within a week following surgery.