Methods of surgical treatment of bilateral paralytic laryngeal stenosis

Abstract

Median stenosis of the larynx, occurring due to paresis or paralysis of the vocal cords, is the most severe pathology in terms of disablement, the treatment complexity and further rehabilitation. Amid the high surgical activity on the organs surrounding larynx, an increase in patients with this pathology is observed. The main surgical approaches in the treatment of bilateral paralytic laryngeal stenosis are described. Two main variants of surgical interventions are emphasized: static - aimed at mechanical expansion of airway lumen, dynamic (functional) - aimed at vocal cord mobility restoration. In considering options aimed at the mechanical expansion of the laryngeal lumen, surgical technique is conventionally used. Most of the authors used removal of the anatomical structures of the larynx to expand its lumen - the vocal cords, arytenoid cartilage, or both at the same time. However, when using these methods, there are possibility of cicatricial changes in violation of the mucosal integrity with recurrent stenosis, eruption of ligatures with the return of the vocal cords in the original position in lateral fixation. In a number of surgical approaches the high invasiveness, technical complexity of execution, as well as the violation of the protective function of the larynx were registered. Among the dynamic methods neuroplasty with an attempt to restore the laryngeal muscles innervation by suturing intersected part of the nerve «end-to-end» and «end-to-side»; myoplasty, when to restore the vocal cords mobility surrounding muscles of the neck were used; neuromuscular plastic, when reinnervation was performed using nerve-muscle flap, were described. The methods are functional, but they have their own disadvantages. The necessity of further search for effective methods of treatment was shown.