Gostrі zahvoryuvannya throat. Chronic catarrhal laryngitis. Chronic inflammation of the larynx

The throat is a human organ, which can be carried to the upper respiratory paths.

Functions

The throat helps to push through the throat to the dichal system and also according to the herbal system. Also in one of the parts of the throat roztashovani voice calls and protection system (foreseeing the hit of your own way).

Anatomy of the throat and pharynx

The throat may have a large number of nerves, the most important blood-bearing vessels and m'yaziv. They see two parts of the throat - the gourd and the larynx. Continue with the trachea. Functions between the parts of the throat are divided in this order:

• I go into the etching system and try to put the shoe into the distal system.
• The voices of the lingering prickle the larynx.

Pharynx

Insha name of the pharynx - pharynx. It starts in the back of the mouth empty and continues further down the neck. The shape of the pharynx is an inverted cone.

Shirsha chastina roztashovuєtsya on the base of the skull for mentality. The lower part of the vuzka protrudes from the larynx. The outer part of the pharynx continues the outer part of the company - on it, make a rich burrow, like vibrating mucus and helping to soothe the throat for an hour, wash it or go.

The pharynx has three parts - the nasopharynx, the oropharynx, and the other part.

Nasopharynx

Nayvischa part of the throat. She has a soft sky, like a border and, when forged, protects her nose from falling into a new hedgehog. On the upper wall of the nasopharynx there are adenoids - aggregation of tissue on the back wall of the organ. The nasopharynx with the throat and a special passage - the Eustachian tube. The nasopharynx is not flattened, like the oropharynx.

Oropharynx

The middle part of the gourd. To be found behind the mouth empty. Mainly, for which the organ is responsible - delivery is repeated to the organs of the respiratory system. Mova lyudiny mozhliva zavdyaki skorochennyam m'yaziv rota. Even in the empty mouth, language was sown, as if it were spryaє ruhu їzhi into the grass system. The most important organs of the oropharynx are the most stench of the ass in the various throat ailments.

Viddil forging

Naynizhchiy z vіddіlіv pharynx z name, what to say. There is a complex of plexuses of nerves, which allow to subtrim synchronously with the work of the pharynx. Zavdyakov to whom it is necessary to come to the legenia itself, and the hedgehog itself to the stravochid and everything happens at the same time.

Larynx

The larynx is roztashovuetsya in tili such a rank:

• Opposite the largest ridges (4-6 ridges).
• Zzadu - a part of the pharynx without the middle of the larynx.
• In front, the larynx is settled, the zavdyaki group of sublingual m'yazyv.
• Vgori - pіd'yazikova kіstka.
• On the side, the larynx lies with its biceps to the thyroid gland.

There is a skeleton at the throat. The skeleton has unpaired and paired cartilages. Cartilage is covered with slush, ligaments and m'yazami.

Unpaired: person-like, epiglottic, thyroid.

Males: rizhkopodіbnі, scoop-like, cuneiform.

M'yazi larynx, at your heart, also divided into three groups:

• Chotiri m'yazi sounds in the voice of the voice: schitoarytenoid, persnecherpalopodіbny, oblique scooplike and transverse m'yazi.
• Expanding the voice gap only one m'yaz - posterior cricoarytenoid. Vaughn is a steam room.
• There are two minds that strain the voices: voice and cricoid.

Larynx may enter.

• Behind this entrance - scoop-like cartilage. The stinks are formed from the rіzhkopodіbnih humps, which are located on the side of the mucous membrane.
• An epiglottis in front.
• From the sides - aryepiglottic folds. The stench is formed from wedge-shaped humpbacks.

The empty larynx is divided into three parts:

• The anterior day - extends from the anterior folds to the epiglottis, the folds are settled by the mucous membrane, and between these folds is a gap.
• Mіzhshlunochkovy vіddіl - nayvuzhchy. It stretches from the lower voice links to the upper voice links. The very thin part of it is called the vocal fold, and it is made up of intercartilaginous and retinal tissues.
• Podgolosova region. Vykhodyachi z name, ozumilo, scho to be found at the bottom of the vocal cavity. Expands and repairs the trachea.

The larynx has three shells:

• The mucous membrane - on the surface of the vocal cords (stinks from a flat non-keratinized epithelium) is formed from a rich-nuclear prismatic epithelium.
• Fibrous-cartilaginous shell - is composed of elastic and gialino cartilage, like a sharpened fibrous tissue, that secures the entire structure of the larynx frame.
• Happy tissue - happy part of the larynx and other parts of the shi.

The larynx is distinguished for three functions:

• Zahisna - in the mucous membranes there are blinking epithelium, and in the new one there is a rich burrow. And as soon as the hedgehog drank, then the nerves complete the reflex - a cough, which leads back from the larynx to the mouth.
• Dikhalna - connected with the front function. The voice gap can shrink and expand, thereby directing the streams of wind.
• Voice lighting - language, voice. Characteristics of the voice lie in the individual anatomical life. she will become voice calls.

On a little budova larynx

Illness, pathologies and injuries

Іsnuyut such problems:

• laryngospasm
• Lack of voice communication

4.1. CLINICAL ANATOMY OF THE LARGENT

Larynx (Larynx) It is an empty organ, which by the upper vent passes into the laryngopharynx, and by the lower one passes at the trachea. The throat is rotting under the sublingual brush on the front surface of the neck. In the middle of the throat, it is covered with a mucous membrane and is composed of a cartilaginous skeleton, bound with ligaments, slush and mud. The upper edge of the larynx is located between IV and V cervical ridges, and the lower edge is along the VI cervical ridge. The ringing of the larynx is covered with m'yazami, pіdshkіrnoy kіtkovina that shkіra, scho easily zmіschuєє, scho allows to carry out її palpation. The larynx is actively moving uphill and down during rozmovі, spіvі, dyhannі and kovtannі. Crimea of ​​active ruhiv, it is passively shifting right-handed and left-handed, with which it is called crepitation of the cartilaginous larynx. In times of damage with evil plump, the laryngeal frilliness is active and changes, like a passive displacement.

In humans, near the upper part of the thyroid cartilage, one can clearly see and smear the ledge, or the day is a kadik, or Adam's apple. (prominentia laryngea, s. pomum Adami). In women and children, they have fewer expressions, and the slightest palpation is more difficult. In the lower part of the larynx, in front between the thyroid and cricoid cartilages, the area of ​​the terminal ligament can be easily smeared (lig. Conicum, s. cricothyreoideum), yaku roztinayut (konіkotomіya) for the need for a terminology of breathing in cases of asphyxia.

Cartilages of the larynx. Skeleton of the larynx folds cartilage (cartilagines laringis), connected with links (Fig. 4.1, b). Three single and three male cartilages of the larynx are distinguished:

Three singles:

1) person-like cartilage (cartilago cricoidea);

2) thyroid cartilage (cartilago thyreoidea);

3) epiglottal cartilage (cartilago epiglotica) abo epiglottis (Epiglottis).

Rice. 4.1. Skeleton of the larynx:

a - front view; b - rear view: 1 - thyroid cartilage; 2-critic cartilage; 3 - epiglottis; 4 - arytenoid cartilage; 5 - tracheal ring; b - sublingual cyst

Three guys:

1) arytenoid cartilage (cartilagines arytaenoidea);

2) rіzhkopodіbnі cartilage (cartilagines corniculatae);

3) cuneiform cartilage (Cartilagines cuneiformes, s. Wrisbergi).

Ring-like cartilage (cartilago cricoidea)є the basis of the skeleton of the larynx. Behind the shape of the wines, I guess the right ring, wrapping it with a signet. Vuzka part, animal forward, called an arc (arcus), and the back is expanded - with a signet and a plate (Lamina). The lateral surfaces of the cricoid cartilage form the upper and lower loamy maydanchiki for articulation with arytenoid and thyroid cartilages clearly.

thyroid cartilage (cartilago thyreoidea), the largest cartilage of the larynx, rotting over the cricoid cartilage (Fig. 4.2). My name is thyroid cartilage, which confirms and looks like a roll from behind the inner part of the organ. Two irregularly shaped chotiric plates, from which cartilage is formed, at the site of growth

Rice. 4.2. thyroid cartilage

a comb is made in front along the middle line, at the upper edge of which there is a virizka (ta-sura thyreoidea). On the inner surface of the kuta, covered with plates of the thyroid cartilage, there is a sound, which is attached to the voice folds. From both sides

posterior ridges of the plates of the thyroid cartilage are formed by young growths that go uphill and down - the upper and lower horns (cornila). The lower ones - more short - serve for articulation with the cricoid cartilage, and the upper straight lines at the bik sublingual cyst, decompose with the great її horns of the thyroid membrane. On the outer surface of the plates of the thyroid cartilage, a scythe line is stitched (linea oblique), scho go back in front of that animal down, until a part of the splendid m'yazіv larynx is attached.

epiglottic cartilage (cartilago epiglottica) or the epiglottis, is a leaf-like plate, which guesses the petals of the flower. The wide part of yoga is free to stand over the thyroid cartilage, it is ruffled behind the root of the tongue and is called a pellet. Vuzka lower part - stalk (petiolus epiglottis)- for help, the connection is attached to the inner surface of the thyroid cartilage. The shape of the epiglottis paddle is sagging due to the fact that the veins are thrown back, the pressures are raised, or the burns, which sometimes causes a pardon during tracheal intubation.

arytenoid cartilage (cartilagines arythenoideae) to form the shape of trihedral pyramids, the tops of which are straight uphill, sprat back and medially. The base of the pyramid is articulated from the superficial cartilage of the cricoid cartilage. To the anterior-internal kuta of the base of the arytenoid cartilage - the vocal bud (processus vocalis)- voice m'yaz is attached, and before the anterior (processus muscularis) - the back and the bichna are red-cherpalo-like m'yazi. To the lateral surface of the pyramid of the arytenoid cartilage in the region of the anterior lower third, the dowgast fossa was deformed, another part of the vocal tract was fixed.

Cuneiform cartilage (cartilagines cuneiformes, s. Wrisbergi) roztashovuyutsya in the comrades of the scoop-epiglottic fold.

Rzhkopodіbnі cartilage (cartilagines corniculatae) roztashovuyutsya over the top of scoop-like cartilage. Cuneiform and rhizhkopodіbnі cartilage - small behind the dimensions of the sesamopodіbnі cartilage, not constant behind the shape of those dimensions.

Sooty throat. The larynx has two pairs of swamps.

1. Cricothyreoidea (articulatio cricothyreoidea) solutions to the flank of the cricoid cartilage and the lower horn of the thyroid cartilage. Nahlyayuchis have tsomu swag forward or backward, the thyroid cartilage itself zbіlshuє or change the tightness of the vocal folds, changing the height of the voice.

2. Ring-shaped loam (articulatio cricoarytenoidea) the lower surface of the arytenoid cartilage and the upper loamy maydanchik of the plate of the cricoid cartilage. Ruhi in the cricoarytenoid globule (forward, backward, medial and lateral) determine the width of the glottis.

Tangles of the larynx (Figure 4.3). The main links of the larynx can be seen:

Rice. 4.3. Tangles of the larynx:

a - front view; b - posterior view: 1 - lateral thyroid lingual, 2 - cricotracheal, 3 - cricothyroid, 4 - aryepiglottic fold

Shitopid'yazychna sredne ta bіchna (Tig. Hyothyreoideum medium et lateralis);

shieldepiglottis (Tig. thyreoepigtotticum);

sublingual epiglottis (Tig. Hyoepigtotticum);

cricotracheal (Tig. cricotracheate);

cricothyroid (Tig. cricothyroideum);

scoop-epiglottic (Tig. aryepigtotticum);

lingually epiglottal median and bichna (Tig. gtossoepigtotticum medium et tateratis).

Thytopid'lingual median and lateral linksє parts of the thyroid membrane (Membrana thyrohyoidea), for help, the larynx is raised to the sublingual cyst. The middle thyroid-lingual ligament is the posterior upper edge of the thyroid cartilage with the body of the sublingual cyst, and the lateral one is with the great ridges of the sublingual cyst. The crack opens at the outer part of the thyroid-lingual membrane to pass the vascular-nerve bundle of the larynx.

Thyroid-epiglottic ligament behind the epiglottis from the thyroid cartilage in the region of the upper edge.

Sublingual epiglottis zv'yazuvannya posterior epiglottis from the body of the sublingual cyst.

Ringotracheal ligament tie the throat with the trachea; pierced between the cricoid cartilage and the first ring of the larynx.

Cricothyroid, or finite, ligament covers the upper edge of the cricoid cartilage and the lower edge of the thyroid cartilage. The cricothyroid ligament is a continuation of the elastic band of the throat (conus etasticus), yak starts on the inner surface of the plates of the thyroid cartilage in the area of ​​\u200b\u200bthe kuta. Zvіdsi elastic tufts vaguely diverge vertically down to the upper edge of the cricoid cartilage arc like a cone, satisfying the final ligament. The elastic membrane fills the gaps between the inner surface of the cartilage and the mucous membrane of the larynx.

Voice foldє upper-posterior bundle of an elastic cone; curves the vocal membrane, which is stretched between the inner surface of the thyroid cartilage in front and the vocal cord (processus vocatis) arytenoid cartilage posteriorly.

Scoop-epiglottic ligament raztashovana between the lateral edge of the epiglottis and the inner edge of the arytenoid cartilage.

Linguistically-epiglottic median and bichna ligament to cover the middle part of the root of the tongue with the anterior surface of the epiglottis, between them there is a burial - the right and left of the fossa of the epiglottis (valekuli).

M'azi larynx (Figure 4.4). The mustache of the larynx can be divided into great groups:

1) ovnіshnі m'yazi, scho to take the fate of rusі vsієї larynx as a whole;

2) internal m'yazi, which sound like a collapse of the cartilaginous larynx like one of the other; tsі m'yazi take part in the safe functions of the breath, sound making that forging.

Zovnishhnі m'yazi fallow in the place of attachment of them, you can add two more groups:

Rice. 4.4. M'yazi larynx:

a - ovnishnі m'yazi: 1 - sternum-pod'lingual, 2 - pіdborіdno-pod'yazichna, 3 - shilopіd'іzichna, 4 - bifurcation, 5 - sternum-thyroid-like, 6 - thyroid-pіd'yazychna, 7 - sternocleidomastо-papillary , 8 - pen; b - internal m'yazi: 1 - oblique arytenoid m'yaz, 2 - aryepiglottic, 3 - transverse arytenoid, 4 - posterior cricoarytenoid, 5 - cricothyroid

1 TO first group there are two boys of m'yazi, one of them is attached to the thyroid cartilage, and the other one is to the bones of the skeleton:

sternothyroid (M. sternothyroideus);

shitopid'yazychna (M. thyrohyodeus).

2. M'yazi other group attach to the sublingual cyst and skeletal brush:

Grudinopіd'yazychna (M. sternohyoideus);

scapular-sublingual (m. omohyoideus);

shilopid'yazichna (m. stylohyoideus);

Dvocherevna (M. digastricus);

Pіdborіdno-pod'yazychna (M. geniohyoideus). Internal m'yazi larynxes wink at the larynx

1. Change the position of the epiglottis during the act of forging it in the breath, improving valvular function.

The position of the epiglottis changes two pairs of m'yaziv-antagonists.

Cherpalonepiglottic m'yaz (m. aryepiglotticus) ripped between the top of the arytenoid cartilage and the lateral edges of the epiglottis. Being covered with a mucous membrane, this mucosa forms a scoop-epiglottic fold in the region of the lateral inlet to the larynx. At the act of forging the shortness of the scoop-epiglottic meat, bring it up to pulling the epiglottis back and down, so that the entrance to the larynx curls up and moves laterally to the pear-shaped fossa to the entrance to the stravochid.

Thyroepiglottic m'yaz (m. thyroepiglotticus) stretched from the sides over the thyroid-epiglottic ligament between the inner surface of the thyroid cartilage and the lateral edge of the epiglottis. When the thyroid-epiglottic membrane is shortened, the epiglottis rises and it opens at the larynx.

Lateral persnecherpalopod_bny m'yaz (m. cricoarytenoideus lateralis)(pair) starts on the bichnіy surface of the ring-shaped

cartilage and attach to the m'yazovy dross of the arytenoid cartilage. At the її fast-paced m'yazovі, the teenagers fall forward and down, and the voices of the teenagers come closer, sounding the voice gap.

Cross scoop-like m'yaz (m. arytenoideus transverses) povyazuє between themselves posterior surfaces of the arytenoid cartilages, as if they are fast approaching, sounding like a voice gap, more importantly at the posterior third.

Oblique scoop-like m'yaz (m. arytenoideus obliqus)(Steam) starts on the posterior surface of the m'yazovy dross of one arytenoid cartilage and attaches in the region of the top of the arytenoid cartilage of the protylogenous side. Having offended scythe scoop-like m'yazi, it strengthens the function of the transverse arytenoid m'yaz, spreading without being in the middle behind it, crossing with it between itself under the host's kut.

Hind cricoarytenoideus post. s. posticus starts on the posterior surface of the cricoid cartilage and attaches to the m'yazovy bud of the arytenoid cartilage. When inhaling, it rushes out, m'yazovі buds of arytenoid cartilages turn at the same time, and the voices at the same time from the vocal folds come out dead, widening the lumen of the larynx. The whole m'yaz, which opens the voice hole. With paralysis, the lumen of the larynx closes, and the breath becomes unbearable.

Shield-like m'yaz (m. thyreoarytaenoides) starts on the inner surface of the plates of the thyroid cartilage. Directly dozadu and burn, it attaches to the lateral edge of the arytenoid cartilage. In case of shortness of the arytenoid cartilage, it wraps around its posterior axis of the name and moves forward.

Cricothyroid m'yaz (m. cricothyroideus) attach with one tip to the anterior surface of the cricoid cartilage on the side in the middle line, the other - to the lower edge of the thyroid cartilage. When the m'yaza is short, the thyroid cartilage sags forward, the voice folds are stretched, and the voices are sounded.

Voice m'yaz (m. vocalis)- trigolova, to become the main mass of the vocal fold; the area of ​​the lower third of the kut, studded with the inner surfaces of the plates of the thyroid cartilage, begins to begin, and it fastens to the voice of the arytenoid cartilage.

On the medial edge of the m'yazi to pass a shackle of elastic tissue, which plays an important role in illuminating the sound. When the voice is short, the folds become thick and short, the springiness changes, the shape and tightness of the okremikh її dіlyanok, which plays an important role in the voice.

TOPOGRAPHY OF THE LARYNX

Larynx advancing to the sublingual cyst with a shield-and-lingual membrane; to the bottom, go over to the trachea, attaching to it with a ring-tracheal ligament. From the front, the throat is covered with a skin, under the skin, with a skin, with a superficial fascia of the skin, with m'yazami. To the lower part of the cricoid cartilage, the fascia of the thyroid gland is attached in front, the biceps of which cover the mud. (M. sternothyroideus et m. sternohyoideus). The anterolateral surface of the larynx is covered with sternum-lingual mucus, and under it, sternothyroid and thyroid-lingual mucus is covered. The back throat is between the laryngeal opening of the pharynx and the entrance to the stravochid. On the sides of the larynx lie the vascular-nerve bundles.

Bloody larynx zdіysnyuєtsya two arteries:

Upper laryngeal (a. laryngea superior);

lower laryngeal (A. laryngea inferior).

superior laryngeal arteryє gіlkoy superior thyroid artery (A. thyreoidea superior), yak, with his black, enter into the outer carotid artery. The upper laryngeal artery is larger, lower lower. At the warehouse of the vessel-nerve bundle of the larynx (a. laryngea superior, v. laryngea superior, ramus internus n. laryngei superior) the artery enters the throat through an opening at the outer part of the thyroid membrane. In the middle of the throat, the upper laryngeal artery divides into smaller needles, where one more needle enters. middle laryngeal artery (a. laryngea media), as an anastomosis with the same artery of the protractile side in front of the conical ligament.

Inferior laryngeal arteryє gіlkoy lower thyroid artery (a. thyreoidea inferior), yak take the cob from the thyroid trunk (truncus thyreocervicalis).

Venous vision administered cranially through the superior thyroid vein. (v. laryngea superior) at the internal jugular vein (v. jugularis interna), caudally - through the inferior thyroid vein (v. laryngea inferior) at the brachiocephalic vein (v. brachiocephalica).

Lymphatic system larynx is subdivided into:

upper vіddіl;

areas of vestibular folds and laryngeal ducts. Lymph sounds, converging with other lymphatic vessels, direct vein of the laryngeal vascular-nerve bundle in the deep cervical lymphatic nodes, expansion of the vein of the deep jugular vein.

Lymphatic judges lower vіddilu pass under and over the cricoid cartilage, climbing at the anterior larynx lymph nodes. In addition, there is a connection with deep lymph nodes in the neck, distended with a deep jugular vein. Contralateral metastasis is not here caused by a ligation with pre-paratracheal lymph nodes. The great clinical significance is the connection between the lymphatic system of the lower larynx and the mediastinal lymph nodes.

Innervation of the muscles of the larynx take care of two needles of the bulging nerve:

superior laryngeal nerve (n. laryngeus superior);

inferior laryngeal nerve (n. laryngeus inferior s.n. recurrens).

superior laryngeal nerveє zmіshanim and enter the globus nerve in the area of ​​the lower vertebral node of the globulous nerve (Ganglion nodosum n. vagi). Behind the great crest of the sublingual cyst, the superior laryngeal nerve divides into two hilars: (r. externus), rukhovy, inner cricoid, and inner nail (r. internus), penetrating through the opening into the thyroid membrane; she gives sensitive little needles to the mucous membrane of the larynx.

Lower laryngeal nerve (n. recurens) zmіshany, іnnervіє іn vіshі sіnіshnі m'yazi larynx іn іnіаtkі cricothyroid mіyaz and іnnervіє sensitive іnnervatsiyu mucosal tunic of the lower larynx, including the region of the vocal folds. The lower laryngeal nerves on the other sides are the extensions of the right and left rotary nerves, as they enter the bulging nerve at the thoracic emptying on the different level. The right slewing nerve enters the bulging nerve on the subclavian artery, the levial ​​nerve - at the point of the bulging nerve of the aortic arch. Farther back nerves of both sides rise uphill to the larynx,

guiding the number of trachea and stravokhod on its own way, with which the right one is rotting sideways between the trachea and stravokhod, and the left one lies on the front surface of the stravokhod.

The sympathetic nerves enter the superior cervical sympathetic cervicothoracic (mirror) node (Ganglion stellatum).

Empty larynx (cavitas laryngis), the shape of a sad night year is sounded in the middle middle and expanded uphill and down. For clinical and anatomical signs, її are divided into three surfaces (Fig. 4.5):

upper- Anterior larynx (Vestibulum laryngis)- rotting between the entrance at the throat and the vestibular folds, which may look like a cone-shaped emptiness that sounds from the bottom;

Enter at the throat in front of the epiglottis, in the back - with the tops of the arytenoid cartilages and from the sides - the scoop-epiglottis

My folds, at the bottom of the vіddіlі yaky, rіzhkopodіbnіbnі and cuneiform cartilages lie down, which make the same humps. Mіzh scrabble-epiglottic folds and the walls of the pharynx are folded pear-like intestines (recessus piriformes), like a posterior larynx to pass in stravochid. On the bottom of the pear-shaped sinus there is a fold of the mucous membrane, which goes backwards and downwards, is covered with the internal gulka of the superior laryngeal nerve and the upper laryngeal

Rice. 4.5. Above the larynx: 1 - upper; 2 - medium; 3 - lower

artery. Buried between the median and lingual-epiglottic folds, as if to cover the anterior surface of the epiglottis with the root of the tongue, are called lingual-epiglottic burrows, or valleculae (valleculae epiglotticae). On the level of the middle and lower thirds of the thyroid cartilage in the empty larynx, two pairs of horizontal folds of the mucous membrane are folded along the sides in the middle line. The top pair is called folds in front (plica vestibularis), lower - vocal folds (plica vocalis). The length of the vocal folds of the new people should be 0.7 div; in women - 1.6-2 cm; in humans - 2-2.4 cm. From the skin side between the vocal and vestibular folds - larynx(Morganiev) shlunochki (ventriculi laryngis), in some names and forward є swish, to go burn down. In the mucous membrane of the laryngeal mucus membranes, there is an accumulation of lymphadenoid tissue, which is sometimes called laryngeal tonsils, and when it is inflamed, it is evidently laryngeal angina. The width of the lumen (voice line between the vocal folds at the posterior third) of the larynx should be close to 15-22 mm in humans, 13-18 mm in women, and 8-11 mm in children of 10 children.

The mucosa of the larynx is the continuation of the mucosa of the empty nose and pharynx and is covered mainly by opal-shaped cylindrical epithelium. The vocal folds, the upper part of the epiglottis, scoop-like folds, and the larynx on the surface of the scoop-like cartilages are lined with rich flat epithelium, which is important to check for the diagnosis of chubby diseases.

4.2. CLINICAL ANATOMY OF THE TRACHE AND KHARCHOVIK

Trachea (tracheae) - This is an empty cylindrical tube, so that there is no middle passage of the larynx (Fig. 4.6). The trachea begins on the level of the body of the VII cervical ridge and extends to the line of the body of the IV-V thoracic ridges, and ends with a bifurcation (bifurcation) on two smut bronchi. Riven bifurcation is high in young people. The length of the trachea becomes in the middle 10-13 cm.

Rice. 4.6. Skeleton of the trachea

ki trachea (Paries membranaceus tracheae). Tsya retina may have elastic and collagen fibers in its own warehouse, and later and transverse smooth m'yazovi fibers in larger deep balls. The width of the retinal wall is no more than 10-22 mm. Hyaline cartilage of the trachea (cartilagines trachealis) tie between yourself for the help of ring-like ties (Lig. annularia). The inner surface of the trachea is lined with mucous membrane,

covered with a cylindrical, blinking epithelium. In the submucosal ball, the mucosal secretion is spread, yakі vibrating a protein-mucous secret. Z inner side trachea in the musculature under the two smut bronchi, the spur of the scapular form is established - the place of closing of the medial walls of the head bronchi - the tracheal spur (Carina trachea).

The right bronchus is broader, enters the trachea from the point 15°, 3 div; leviy - under the kutom 45 °, yogo dozhina 5 cm. Thus, the right bronchus is practically an extension of the trachea, at the connection with which in the new part the third-party body is used.

TOPOGRAPHY OF THE TRACHEA

Above the trachea is attached to the cricoid cartilage of the cricotracheal link (Lig. cricotrachaele). At the cervical part to the anterior surface of the trachea, the isthmus of the thyroid fossa lies, and from the sides - її parts. The back of the trachea lie down to the stravokhod. The right hand in the trachea contains the brachiocephalic stovbur, the left hand is the left carotid artery (Fig. 4.7).

The aortic arch is in front of the trachea in the chest. The right hand in the trachea is ripped out of the right pleural sac and the right bulging nerve, the left hand is the aortic arch, the left carotid and subclavian.

Rice. 4.7. Topography of the trachea: 1 - thyroid fold; 2 - sunken carotid artery; 3 - aortic arch; 4 - forked ridge; 5 - bulging nerve

arteries, levi rotatory nerve. In children up to 16 years of age, the thymus folds in front of the trachea in front of the trachea.

Bloody trachea seek help for the lower thyroid (a. thyroidea inferior) that internal thoracic artery (a. thoracica interna), and also for

flare of the bronchial tubes of the thoracic aorta (Rami bronchiales aortae thoracicae).

IN tracheal innervation to take the fate of a deadly and bloated nerve (n.vagus) and tracheal tubercles of the inferior laryngeal nerve (N. Laryngeus inferior). A nice infusion of ideas by nerves that come out of a pretty trunk (truncus sympathicus).

Lymph trachea protrudes mainly into the lymph nodes, spreading from both sides and from both sides. In addition, the lymphatic system of the trachea may have connections with the lymph nodes of the larynx, the upper deep cervical nodes and the anterior mediastinal nodes.

Stravokhid It is an empty organ at the look of the tube, like the back of an empty pharynx with an empty sluice. From above, the bow is transformed into a stravochid at the projection of the VI neck ridge, less on the level of the lower edge of the cricoid cartilage. At the bottom of the passage, the stravokhod to the chute passes the line of the XI thoracic ridge. The length of the stravokhod in a grown-up person becomes an average of 23-25 ​​div, and the width is from 15 to 20 mm.

The stravokhod has three different signs:

Breast;

Cherevny.

Shiyny Viddil stretches along the line of the VI neck ridge to the thoracic ridge, and the dorsum is pierced at 5 to 8 cm.

Breast child the maximum length is 15-18 cm and ends on the line X-XI of the thoracic ridges at the entrance to the diaphragm through the stravochidny opening (Hiatus esophageus).

Cherevniy vіddіl maє 1-3 cm zavdovka and ends with small expansions at the mіstsі transition to the sleeve.

Stretching in front of the ridge, the stravohid on its way may chotiri vagini (two in the sagittal and two near the frontal plane) and three sounds. First sound located near the transition of the pharynx into the stravochid (15 cm from the upper edge of the cuts). The pressure of the aorta and the left head bronchus is called another sound stravokhod. third sound- at the place of passage through hiatus esophageus(Figure 4.8).

The cervical carotid arteries and the laryngeal nerves lie close to the stravohod at the sides of the neck. In the thoracic vertebrae, on the lines IV-V of the thoracic ridges, the stravochid passes the order from the arch of the aorta. In the lower third of the stravochid, there is a pericardial paddle, which crosses at the hip part, as in front it is covered with a paddle of the left part of the liver.

The wall of the walker has three balls: inner (mucus), middle (m'yazovy) and outer (happy tissue).

Innervation Stravokhod (plexus esophagealis).

bloodshed the lower thyroid-

Rice. 4.8. Physiological sounds to the stravokhod

new artery (a. thyroidea inferior), in the thoracic cavity - stravochidny and bronchial arteries (aa.esophageae, bronchiales), at the celiac vіddіlі - the left slunk artery (a. gastric sinistra), lower left nirk artery (a. phrenica inferior sinistra).

4.3. CLINICAL PHYSIOLOGY OF THE LARNAYA, TRACHEA AND HARCHOVIC

Larynx and trachea dihalnu, zahisnu that voice-illuminating function.

Dihal function- to carry out the larynx in the lower part of the mouth - the trachea, bronchi and lungs. The voice gap expands with inhalation, and the expansion of the voice gap varies widely according to the needs of the body. With a deep inhalation, the voice gap expands more strongly, and it is often possible to see the bifurcation of the trachea.

The opening of the vocal tract is reflexively felt. It is breathed in again to tease the number of nerve endings in the mucosa, as a result of which the impulse along the afferent fibers of the upper laryngeal nerve through the flaccid nerve is transmitted to the dichal center on the day of the IV duct. Sounds along the efferent fibers are necessary for rukhovі іpulsi to m'yazіv, scho expand the voice gap. Under the influx of this teasing, there is a stronger function of those other m'yazyv, which take part in the dichal act, - intercostal and m'yazyv diaphragms.

Zahisna function The larynx is connected with the presence of three reflexogenic zones of the mucous membrane of the larynx (Fig. 4.9):

The first part of them is ripped at the entrance to the larynx (the laryngeal surface of the epiglottis, the mucous membrane of the aryepiglottic folds);

The third zone is expanded in the sub-voice space on the inner surface of the cartilage. Receptors, embedded in these areas, have all kinds of sensitivity - tactile, temperature, chemical. When the mucous membrane of these zones is teased, there is a spasm of the vocal tract, which is why the lower dychal passages are protected from the fall of the line, and also from third-party objects.

Rice. 4.9. Reflexogenic zones of the larynx (marked with arrows)

An important manifestation of the respiratory function of the larynx is a reflex cough, which is due to the teasing of the reflexogenic zones of the larynx and the vocal space. Third-party objects are coughing up with a cough, like a windy path in the wind.

Nareshti, on the level of the entrance to the larynx, there is a subdivision of the dichal and herbal tracts. Here, behind the figurative Vistula V.I. Voyachek,

є zlagodzhenno dyuchy mehanіzm zaliznichnoї strіlki. Under the hour of the act of forging, the larynx rises uphill and forward to the root of the tongue, the epiglottis swells up to the rear and closes the entrance at the throat, approaching the back of the pharynx. Kharchovy masses wrap around the epiglottis from two sides and trap at the pear-like sinus, and then at the mouth of the stravokhod, which at the same time excites. In addition, vestibular folds stool and scaly-like cartilages sag forward in the case of oval ruches.

The mechanics of creating sounds and molding moves take part in the use of the dichal apparatus: 1) legenia, bronchi and trachea (Lower resonator); 2) voice box larynx; 3) an empty mouth, pharynx of the nose and paranasal sinuses, in which resonating sound and yak can change its shape with the hands of the lower cleft, lips, and cheek (Upper resonator).

To appease the sound of the voice, the hole must be closed. Under the onslaught of the wind from the lower resonator, the voice gap cracks for the elasticity and firmness of the vocal folds. Zavdyaki tsim forces after the stretching and uphill phase is coming

turn, and the voice gaps again fade. Then the cycle is repeated, with which the vibration of the jet is repeated over the vocal folds and the vocal folds are vibrated at the same time. The stench of zdіysnyuyut kolivalnі ruhi in a transverse straight line, in the middle and name perpendicularly to the jet of wind, which is visible. The frequency of kolyvalnyh ruhіv vocal folds in vіdpovіdє vysoti tone, as you can see, tobto. sound is created. Bazhayuchi to move the sound of a singing height, people, with a fast singing rank of laryngeal m'yazi, reflexively vocal folds give the necessary strength and tension, and the upper resonators - a singing form. The scheme of cleavage of the vocal folds is similar to the vibration of a steel plate in the form of a line, as there may be one end of typing, and the other will be. Yakshcho vіdkhility i vіdpusti її vіlny kіnets, there will be a sound and see the sound. The larynx has the same scheme, only strength, which calls for a knock (pressure again in the trachea) for quite a long time. Everything should be brought to normal sound illumination. chest registry. Named to resemble the fact that with a voiced sound, you can pick up the anterior wall of the chest with your hand.

On vіdminu vіd tsogo falsetto the voice of the chink does not close, the chink of the chink is left, which, with the strength to go through again, leading to the tumbler, less than the edges of the folds close to each other. In this way, as in the chest register of the voice, the folds are tense, sweaty and closed, then in falsetto the stench is seen as flat, strongly stretched and not closed on the surface, the sound is high, but weak behind the chest.

The sound has its own characteristics and is considered for height, timbre and strength. The height of the sound is connected with the frequency of the vocal folds, and the frequency, with its own line, is with its own strength and tension. During the period of growth of a person, the expansion of the vocal folds changes, which leads to a change in the voice. Changing the voice, or else a fracture (mutation), is due to the hour of state maturity (between 12 and 16 fates). For boys, the voice from the treble chi alto goes to tenor, baritone chi bass, for girls - to soprano chi contralto. Empty your mouth and nose

being the upper resonator, they add some overtones to the guttural sound, after which the singing timbre swells. By changing the position of the cheek, tongue, lips, it is quite possible to change the timbre of sounds, and even less singing boundaries. The characteristic of the timbre of the voice of a skin person, even if it lies in the state of that age, is distinguished by a wine-colored individuality, so we know the voices of well-known people.

Physiological role of the stravokhod- Carrying out їzhi in a slug. At an empty company, the grub breast is tucked in front and urinates like a slug. Mova proshtovhuє prepared a breast їzhi to the root of the tongue, which calls out the oval act. At this hour, the throat rises and burns out. The entrance at the larynx is curled up with the epiglottis, turning back at the empty mouth is blocked by the roots of the tongue, which rises, and the grub breast, protruding through the pear-like sinuses, is consumed in the stravochid. The passage of the hedgehog along the stravokhod is observed in the wake of yogo peristaltic ruhіv: the stravokhod, which lies without the middle of the food breast, squirms, and the lower lying vіddіl relaxes, the breast, as it were, is squeezed into the vіddіl stravokhod. It takes 4-5 seconds to pass the breast with a stravokhod to the shunt.

Kovtannya is a foldable reflex act. The contraction of the musculature of the ovary apparatus develops reflexively due to the involvement of cerebral measles and the flaccid nerve. Obov'yazkovoy umovoy forging є damage to the receptors of the pharynx and the mucous membrane of the stravokhod.

4.4. GOSTRI FUSES OF ILLNESS OF THROAT AND TRACHEA

Hot spots of inflammation of the larynx and trachea often grow as if showing hot spots of inflammation of the upper dyhal passages. The reason for this can be a highly addictive flora: bacterial, fungal, viral, smishana.

4.4.1. Hostria catarrhal laryngitis

Hostria catarrhal laryngitis (laryngitis) - gostre catarrhal inflammation of the mucous membrane of the larynx. As a self-inflicted ailment blamed after the activation of the flora,

saprophytic in the larynx under the inflow exogenous and endogenous factors. Sered exogenous play the role of such factors, like hypothermia, teasing the mucous membrane, injecting professional shkidnosti (drank, gas and іn), trivala thick rozmov in the cold, living even colder or hotter. Endogenous factors: reduced immune reactivity, ailments of the intestinal tract, allergic reactions, age-old atrophy of the mucous membrane. Acute catarrhal laryngitis is often blamed for the state of maturity, if there is a mutation in the voice. Among the various etiological factors in this disease, the role of bacterial flora plays a role - B-hemolytic streptococcus, streptococcus pneumoniae, viral infections; influenza viruses (A and B), parainfluenza, coronavirus, rhinovirus, fungal flora. The flora is most affected.

clinical picture characterized by the appearance of hoarseness, pershinnya, almost discomfort and a third-party body near the throat. The temperature is mostly normal, more likely to move to subfebrile. Damage to the voice-forming function manifests itself as a different stage of dysphonia. Sometimes a sickly turbulent dry cough, which accompanies phlegm.

Pathological changes lead to disruption of blood flow, hyperemia, cellular infiltrates and serous oozing of the mucous membrane of the larynx. With widespread inflammation on the vestibular and laryngeal vocal folds, they can be covered with swollen infl ltrated vestibular folds. When radiating to the subfolding area of ​​the vein, the clinical picture of the milky croup (subfolding laryngitis) is observed.

Diagnostics I don’t imagine any particular difficulties, shards are grounded on pathognomonic signs: hoarseness, often due to a singing cause (cold hedgehog, GRVI, cold, movne navantazhennya that іn.); characteristic laryngoscopy picture - pronounced hyperemia of the mucosal membrane of the entire larynx or only the vocal folds, sweating, swelling and inconsistent contraction of the vocal folds; the presence of a temperature reaction, as there is no respiratory infection. To acute laryngitis, varto and vaping, if there is only marginal hyperemia of the vocal folds, shards of the surroundings of the process, yak і

spilled, shilly go to chronic form. Children with laryngitis need to be differentiated from an extended form of diphtheria. Pathological anatomical changes in this period will be characterized by a development under the vocal folds of fibrinous inflamed with brudno-syrih spleen, intimately tied with fabrics that swell (true croup).

Rozhevu urazhennia mucus larynx in the catarrhal process clear christening of the cordons and one-hour illness of the skin coverings.

Likuvannya. In case of proper treatment, the disease ends with an adequate treatment for 10-14 days; more than 3 times more likely to tell about the transition to a chronic form. The most important and indispensable jubilant approach is the dominance of the voice mode (moving mode) to the subsidence of the most flamboyant manifestations. Not keeping the sparing voice mode like zatrimaє oduzhannya, but accept the transition to the process in a chronic form. It is not recommended to take hospitality, salty water, alcoholic drinks, chicken. Medical therapy is important to have a medical character. Efficient inhalation and expansion of the mucous membrane with combined drugs, which can be used against anti-seizure components (bioparox, IPC-19 and other), infusion into the throat of drug sums with corticosteroids, antihistamine drugs and antibiotics for 7-10 days. Efficient sums for infusion into the larynx, which consist of 1% oil solution of menthol, emulsion of hydrocortisone with additional drops of drops of 0.1% of adrenaline hydrochloride. At the kіmnati, de perebuvaє ailments, bazhano podtremuvati podvischenu vologіst povitrya.

In case of streptococcal and pneumococcal infections, which are accompanied by elevated body temperature, intoxication of the body, general antibiotic therapy is prescribed: preparations of the penicillin series (phenoxymethylpenicillin 1 million 4-6 times per doba, amoxicillin 500 mg 2 times per doba).

Forecast amiable in the case of high-quality and pre-trimannian voice mode.

4.4.2. Infiltrative laryngitis

Infiltrative laryngitis (laryngitis infiltrativa) - more inflamed larynx, in which the process is not surrounded by a mucous membrane, but expands on deep-lying tissues. The process may have a m'azovy apparatus, ligaments, perichondrium.

Etiological factorє bacterial infection that penetrates the tissue of the larynx in case of injury after an infectious disease. Decreased medical and global resistance is a friendly clerk in the etiology of infiltrative laryngitis. The igniting process can be carried out in a seemingly obmezheno chi poured form.

Clinic to deposit in the form of a stage and breadth of the process. At poured form at the ignition process, the entire mucous membrane of the larynx is lit, at the exchange- okremі її dіlyanki: mizhcherpalopodіbny space, vestibular vіddіl, epiglottis, subvoice space. Sickness stings for pain, which is overcome by cov- ing , pronounced dysphonia, high body temperature, self-perception. Possibly cough from coughing up thick mucus-purulent sputum. Looking at these symptoms, there may be impaired dichal function. Regional lymph nodes increased, sharp and painful on palpation.

With irrational therapy or high corollary infection, hostile infiltrative laryngitis can turn into a purulent form. phlegmonous laryngitis (laryngitis phlegmonosa). Pain symptoms in case of cimu sharply increase, body temperature rises, the burning camp becomes worse, breathing becomes more difficult, right up to asphyxia. With indirect laryngoscopy, an infiltrate is revealed, de through the thinned mucous membrane, you can see the abscess, which confirms the abscess. Abscess of the larynx may be the last stage of infiltrative laryngitis and vinica, most importantly on the lingual surface of the epiglottis or in the area of ​​one of the arytenoid cartilages.

rejoicing, call to be carried out in the minds of the hospital. Antibiotic therapy is prescribed as the maximum for this

increased dosing, antihistamines, mucolytics, and, if necessary, short-hour corticosteroid therapy. Emergency surgery is indicated in patients with depression, if an abscess is diagnosed. After mass anesthesia, the abscess is opened with a laryngeal knife (or infiltrate). Massive antibiotic therapy, antihistamine therapy, corticosteroid preparations, detoxification and transfusion therapy are administered simultaneously. It is also necessary to recognize analgesics.

Sound the process fast and easy. For the duration of all illness, it is respectful to follow the camp to the lumen of the larynx and, without checking the moment of asphyxia, work on a tracheostomy.

For the obviousness of the spilled phlegmon with extensions on soft fabrics we roble ovnіshnі razrіzi obov'yazkovo with wide drainages of rotten hollows.

It is important to follow the function of breathing importantly. With the appearance of a sign of severe progressive stenosis, an emergency tracheostomy is required, and with the appearance of unsafe asphyxia, a conicotomy is required.

4.4.3. Subfold laryngitis (hybny croup)

Hibny croup (laryngitis subchordalis, false croup) - hostria laryngitis with an important localization process in the sub-voice space. It is observed in children up to 5-8 years of age, which is due to the peculiarities of the life of the vocal space: the fluff of the cellular tissue under the vocal folds in the children is strongly aggravated and easily reacts to teasing by an infectious agent. The development of stenosis of the esophagus is also the laryngeal stenosis in children, the lability of the nerve and vascular reflexes. With the horizontal position of the child, after a rush of blood, it will increase, I will become more aggravated at night.

Clinical picture. Illness begins to sound from the burning of the upper dyhal channels, congestion and visions from the nose, subfebrile temperature, cough. Zagalny camp of a child is a day full of zadovіlny. At night, breath attacks, a barking cough, cyanosis of the skin curves begin. Zadishka is importantly inspiratory, accompanying

retraction of the soft tissues of the jugular fossa, above and below the subclavian spaces, epigastric region. A similar camp is trivaє in the form of a few wheezes until the fifth year, after which it is clear that the sweat is clear, the breath is normalized, the child is falling asleep. Similar steps can be repeated in 2-3 days.

laryngoscopy picture subchordal laryngitis appears as a roller-like symmetrical swelling, hyperemia of the mucosa under the vocal space (PIC). The ridges protrude from the vocal folds, signifi- cantly sounding through the larynx and making it difficult for them themselves.

Diagnostics. It is necessary to differentiate with true diphtheria croup. The term “hybny croup” indicates that the disease is compared to true croup, if there are fibrinous spitting under the vocal folds, then. diphtheria of the larynx. However, with subfolded laryngitis (hibny croup), the illness is attack-like in nature - the last day of the day changes the difficulty of breathing and the temperature increase at night. The voice in diphtheria is hoarse, in subfold laryngitis it is not changed. With diphtheria, there is no barking cough, like croup. With subfolded laryngitis, there is no significant increase in regional lymph nodes, there is no spitting in the lower larynx, which is characteristic of diphtheria. It is necessary to carry out a bacteriological examination of swabs from the pharynx, larynx and nose for a diphtheria stick.

Celebration directed to the liquidation of the ignition process and the renewal of breath. Efficient inhalations of a combination of anti-abdominal drugs: 5% ephedrine, 0.1% adrenaline, 0.1% atropine, 1% diphenhydramine, hydrocortisone 1.0 and chemopsin. Antibiotic therapy is required, as prescribed at the maximum dose for this age, as well as antihistamine therapy, sedative drugs. The administration of hydrocortisone or prednisolone is shown in the dose of 2-4 mg/kg of the vaginal child. Beneficial for fresh water: tea, milk, mineral pools of water, procedures that excite - scissor baths, gyrchichniks.

An attack of the venom can be tested by zupiniti, by gently touching the spatula to the back of the throat, calling out the vomit reflex.

In times, if you are more likely to come in powerless, and the poison becomes threatening, it is necessary to go to nasotracheal intubation for 3-4 days, if necessary, a tracheotomy is indicated.

4.4.4. Laryngeal angina

Laryngeal angina (angina laryngis) - acute infection with lesions of the lymphadenoid tissue of the larynx, rotting in the morgan ducts, the thorax of the mucous membrane of the aryepiglottic folds, on the bottom of the pear-like sinus, and also in the area of ​​the epiglottic surface. Zustrichaetsya visibly rarely and may pass under the mask of severe laryngitis.

etiological factors, call the ignition process, є different bacterial, fungal and viral flora. Penetration of the buddnik into the mucous membrane can be seen in a double-red or alimentary way. In etiology, the role of hypothermia is also played by trauma of the larynx.

clinical picture rich in why it is similar to the manifestations of angina of the pharyngeal tonsils. Turbulence is at the throat, which is stronger when forged when turning the neck. Possible dysphonia, difficulty breathing. The temperature with laryngeal angina of the temple is up to 39 ° C, the pulse is accelerating. On palpation, pain and enlargement of regional lymph nodes.

During laryngoscopy, hyperemia and infiltration of the mucous membrane of the larynx, which sometimes sounds like a clearing of the dyhal channels, around the follicles with punctate purulent deposits, are indicated. With a prolonged leak, an abscess can form on the lingual surface of the epiglottis, aryepiglottic folds, and other areas of accumulation of lymphadenoid tissue (Fig. 4.10).

Diagnostics. Indirect laryngoscopy with significant anamnestic and clinical data allows you to put correct diagnosis. Laryngeal angina followed by diphtheria diphtheria, as if the mother had a similar break.

Celebration includes broad-spectrum antibiotics (augmentin, amoxiclav, cefazolin, kefzol and in.), antihistamines(tavegіl, fencarol, peritol, claritin and іn), mucolytics, analgesics, antipyretics. In times of guilt, a sign of impaired breathing to exacerbation is given short-hour corticosteroid therapy for 2-3 days. With significant stenosis, emergency tracheotomy is indicated.

Rice. 4.10. Abscess of the epiglottis

4.4.5. Swollen larynx

Swollen larynx (oedema laryngis)- vasomotor-allergic swelling process, which develops rapidly in the mucous membrane of the larynx, which sounds like enlightenment; as a rule, it is a secondary manifestation of some disease of the larynx, and not an independent nosological form.

Etiology. Causes of acute swelling of the larynx can be:

Inflammatory processes of the larynx (subfold laryngitis, hostria laryngotracheobronchitis, chondroperichondritis and other);

Acute infectious disease (diphtheria, kyr, scarlet fever, influenza);

Swelling of the larynx (good-natured, evil-natured);

Injuries of the larynx (mechanical, chemical);

Allergic disease;

Pathological processes of the vascular from the larynx and trachea of ​​the organs (swelling of the mediastinum, stravohod, thyroid slough, pharyngeal abscess, phlegmon of the shi and other).

clinic. The ringing of the larynx and trachea can develop blisteringly (external body, spasm), acutely (infectious illness, allergic processes, etc.) and chronically (against the background of swelling). The clinical picture is to lie down in the degree of ringing of the larynx and the stenosis of the larynx: as soon as the stenosis develops, then the fault is not safe. In the case of a flaming etiology, the throat is turbulent, which is strengthened by forging, watching a third-party body, changing the voice. Expanding on the mucous membrane of the arytenoid cartilage, aryepiglottic folds and subglottic space, the appearance of severe stenosis of the larynx, which reveals an important picture of the poison, which threatens the life of the sick (div. "Stenosis of the larynx").

In case of laryngoscopy follow-up, swelling of the mucous membrane of the affected larynx in the presence of a rare or excruciating swelling is indicated. The epiglottis has its sharp sweats; can be elements of hyperemia, the process expands to

It is characteristic that in case of inflammatory etiology, a different degree of manifestation of the reactive manifestation, hyperemia and infection of the vessels of the mucous membrane are observed, with non-inflammatory hyperemia, it sounds every day.

Diagnostics do not call for difficulties. The disorder of the respiratory tract of a different stage, a laryngoscope picture is characteristic, to give the ability to correctly diagnose the illness. Skladnіshe z'yasuvati the reason for the bang. In some cases, it is hyperemic, swollen, the mucus membrane closes in reality in the larynx, the puffiness, the external body is the same. In a row with indirect laryngoscopy in a number of cases, it is necessary to work with bronchoscopy, radiography of the larynx and chest, as well as other follow-up.

Celebration to be carried out in the minds of the hospital and directly nasampered to the inspiration of the state of mind. Depending on the severity of clinical manifestations, there are conservative and surgical methods of treatment.

Conservative methods indications for compensation and subcompensation stage of the sounding of the dyspial pathways and include the following indications:

1) parenteral wide-spectrum antibiotics (cephalosporins, non-synthetic penicillins, macrolides and others);

2) antihistamine preparations (solution 0.25% pipolfen i/m, tavegilu and in.);

3) corticosteroid therapy (solution to hydrocortisone, prednisolone 3% - up to 120 mg/m); it is recommended to introduce calcium gluconate 10% - 10 ml intravenously, glucose 40% - 20 ml at once with 5 ml of ascorbic acid intravenously;

4) dehydration effects [furosemide (lasix) 20-40 mg internally or internally; bumetanide 1-2 mg intravenously; hypothiazide, tab; veroshpiron, tab; i

One-hour recognition of drugs that eliminate antihistamines, corticosteroids and dehydration drugs (parenterally or intravenously), effectively reduce signs of acute stenosis and improve respiratory distress - drug destenosis.

Even though there are strong manifestations and daily positive dynamics, the dose of corticosteroid drugs to be administered can be increased. The best effect is given by intravenous administration of 200 ml of isotonic sodium chloride solution with the addition of 90 mg of prednisolone, 10 ml of 10% calcium chloride, lasix.

Vіdsutnіst effektu vіd conservative exuberance, the appearance of decompensated stenosis leads to non-gain tracheostomy. In case of asphyxia, an emergency conicotomy is performed, and then, after the restoration of the ovine dyhannia, tracheostomy is performed.

4.4.6. Hostry tracheitis

Hostry tracheitis (tracheitis acuta) - gostre inflammation of the mucous membrane of the lower dycal passages (trachea and bronchi), seldom thickened in isolation; in most of the depressions, the host tracheitis goes down from the flickering changes of the upper dyhal channels - the nose, pharynx and larynx.

Etiology. The reason for the blame for acute tracheitis is infection, the workers of such saprophytes in the wild ways and are activated under the influx of various exogenous factors; viral infections, influx of unfriendly climatic minds, overcooling of the body, professional shkidlivost and іn.

Most often, with an advanced trachea, which is cremated, the bacterial flora is revealed: Staphylococcus aureus, H. influenzae, Streptococcus pneumoniae, Moraxella catarrhallis that in.

Pathomorphology. Morphological changes in the trachea are characterized by hyperemia of the mucous membrane, swelling, moderate or diffuse infiltration of the mucous membrane, blood circulation and expansion of the blood vessels of the mucous membrane.

clinic. A typical clinical sign in tracheitis is an attack-like cough, especially at night. Dry cough on the cob, then mucus-purulent sputum, sometimes with blood streaks. If I attack a cough

varying severity of pain behind the sternum and in the region of the larynx. The voice sometimes loses sonority and becomes hoarse. In some depressions, subfebrile temperature, weakness, unwellness are observed.

Diagnosis stand on the basis of the results of laryngotracheoscopy, anamnesis, sickness, microbiological examination of sputum, radiography of legenia.

Likuvannya. It is necessary for the sick person to provide warmth to the vologer by visiting the host. They prescribe drugs (licorice root, mucaltin, glycyram and other) and proticachlo (libexin, tusuprex, sinupret, broncholith and other) drugs, mucolytic drugs (acetylcysteine, flumucil, bromhexine), antihistamines and other. ), paracetamol. A trace of the uniqueness of the one-hour recognition of the respiratory and proto-cash diseases. A good effect is to kill the stagnation of gyrchichniks on the chest, baths for them.

When the body temperature rises, antibacterial therapy (amoxicillin, augmentin, amoxiclav, cefazolin and other) is recommended for the prevention of low infection.

Forecast with rational and spontaneous therapy, it is friendly and ends with a stretch of 2-3 tyzh. At that very hour, illness can take a long break, or go into a chronic form; sometimes aggravated by low-grade infections: bronchopneumonia, pneumonia.

4.5. CHRONIC FUSES

Chronic inflammation of the mucus membrane and submucosal ball of the larynx and trachea vinikaє under the influence of quiet causes, which in the case of hostile diseases: the influx of unacceptable butovih, occupational, climatic, constitutional and anatomical factors. Sometimes the fuse of illness in the cob nabuvaє chronic perebіgu, for example, with ailments of the heart-vascular and legenev systems.

There are such forms of chronic inflammation in the larynx: catarrhal, atrophic, hyperplastic, diffuse or obstruction, subfold laryngitis and pachydermia of the larynx.

4.5.1. Chronic catarrhal laryngitis

Chronic catarrhal inflammation of the mucous membrane of the larynx (laryngitis chronica catarrhalis) - the most common and easiest form of chronic inflammation. The main etiological role of this pathology plays a role in the trial of the voice apparatus (speakers, lecturers, readers, etc.). An important meaning may be the influx of unfriendly exogenous officials: climatic, professional and shkidlivih zvichok.

clinic. The most common sign is hoarseness, disorder of the voice-making function of the larynx, shortness of breath, change in the timbre of the voice. In the fallow, in the case of the ailment, it is also turbulent, dryness, in the presence of a third-party body of the larynx, cough. Razrіznyayut cough kurtsa, which is blamed on aphids of a thriving hen, it is characterized by a constant, mild, mild cough.

For laryngoscopy markedly reduced hyperemia, swelling of the mucous membrane of the larynx, more than the area of ​​the vocal folds, and pronounced infiltration of the vessels of the mucous membrane.

Diagnostics does not represent difficulties and is based on a characteristic clinical pictures, history and data of indirect laryngoscopy

Likuvannya. It is necessary to use the influence of the etiological factor, it is recommended to use a sparing voice mode (turn on the language and three words). Likuvannya is more important to have a mystical character. In the period of acute infusion into the larynx of antibiotics from a suspension of hydrocortisone: 4 ml of an isotonic solution of sodium chloride with the addition of 150,000 units of penicillin, 250,000 units of streptomycin, 30 mg of hydrocortisone. Tsey warehouse is poured at the throat, 1-1.5 ml of dvіchі per day. This warehouse can be mixed for inhalation. The course of education is carried out for 10 days.

At the mist's victoria medicinal preparations you can change antibiotics after planting on the flora and showing sensitivity to antibiotics. In the warehouse, you can also turn off hydrocortisone, and add chymopsin or flumucil, which will lead to secretolytic and mucolytic effects.

Pleasantly recognized by aerosols for the expansion of the mucous membrane of the larynx and combined preparations, which include an antibiotic, analgesic, antiseptic (bioparox,

ІRS-19). The stagnation of oily oil-oil inhalations is necessary to intervene, shards and preparations have a negative effect on the blinking epithelium, priming and attaching its function.

The role of exaltation of chronic catarrhal laryngitis is great to depend on climatotherapy for the minds of the dry sea coast.

Forecast remarkably accommodating with proper therapy, as it is periodically repeated. In the other case, it is possible to switch the disease to a hyperplastic or atrophic form.

4.5.2. Chronic hyperplastic laryngitis

Chronic hyperplastic (hypertrophic) laryngitis (laryngitis chronica hyperplastica) characterized by obmezhenoyu chi diffuse hyperplasia of the mucous membrane of the larynx. The following types of hyperplasia of the mucous larynx are distinguished:

Pachydermia of the larynx;

Chronic subfold laryngitis;

Vipadannya, or prolapse, blinking slunochka.

clinic. The main scar of the ailing stage is manifested by the hoarseness, stupefaction of the voice, and sometimes aphonia. When the disease is aggravated, pershinnya is turbulent, in the presence of a third-party body during cov- ing, a mild cough with a mucus membrane.

Diagnostics.Indirect laryngoscopy and stroboscopy allow the appearance of obscured or diffuse hyperplasia of the mucosa, the presence of thick mucus, both in the intercranial-like, and in other laryngeal openings.

At diffuse form hyperplastic process, the mucous membrane is sweaty, pasty, hyperemic; the edges of the vocal folds are thickened and deformed on the whole length, so that they are completely closed.

At obmezhennoy form (spіvochі vuzliki) mucous membrane of the throat of erysipelas color without special changes; between the anterior and middle thirds of the vocal folds on the edges of the folded symmetrical gaps in the appearance of successful tissue growths (bumps) on a wide base with a diameter of 1-2 mm.

At pachydermia of the larynx in the intercranial space, the mucosal membrane is thinned, on the superficial and epidermal folds of the veneer, which sounds like a rough tuberosity, there may be granulation on the posterior third of the vocal folds and in the intercranial space. At the enlightenment of the throat, there is a small amount of grain in the yazke, and with the help of a pick.

Vipadannia (prolapse) of the blinking sac vinikaє as a result of a trivial overvoltage of the voice and the ignition process of the mucous membrane of the slug. With forced vision, phonation, coughing, hypertrophic mucosa protrudes from the laryngeal duct and often closes the vocal folds, shifting to a complete fold of the vocal fold, sounding hoarsely in the voice.

Chronic subfold laryngitis with indirect laryngoscopy, a picture of hive croup is predicted; with it, hypertrophy of the mucosa under the vocal space, which sounds in the voice cavity. The anamnesis and endoscopic microlaryngoscopy and biopsy allow clarifying the diagnosis.

Differential diagnostics. The exchange of forms of hyperplastic laryngitis is necessary to differentiate from specific infectious granulomas, as well as from neoplasms. Significant serological reactions and biopsy with further histological follow-up help to make a diagnosis. Clinical evidence shows that specific infiltrates and no symmetrical localization, as from hyperplastic processes.

Likuvannya. It is necessary to use the influx of shkidlivih exogenous factors and obov'yazkove dotrimanya sparing voice-

Rice. 4.11. The form of hyperplastic laryngitis (spіvochі vuzlika) is marked

th regime. In the period of confinement, a treatment is carried out as in case of acute catarrhal laryngitis.

In case of hyperplasia of the mucosal membrane, a point suppression of the lesions of the larynx in 2-3 days is carried out with 10-20% of the spread of the lesion for 2 strokes. The hyperplasia of the mucosa is marked with signifi- cant indications to the endolaryngeal extirpation with subsequent histological follow-up of the biopsy. The operation is carried out with a variety of local anesthesia using lidocaine 10%, cocaine 2%, dicaine 2%. In this hour, such introductions are being made to the selection of endoscopic endolaryngeal methods.

4.5.3. Chronic atrophic laryngitis

Chronic atrophic laryngitis (laryngitis chronica atrophica)- Illness in isolated form, rarely stings. The reason for the development of atrophic laryngitis is most often atrophic rhinopharyngitis. Wash away the navkolishny middle, professional shkidly (drunkenness, gassing, hot air and other), ailments of the mucus-intestinal tract, the presence of normal nasal breathing to relieve the development of atrophy of the mucous membrane of the larynx.

clinic. Conducting scars in atrophic laryngitis - noticeable dryness, pershinny in the larynx and the presence of a third-party body in the larynx, as well as dysphonia of a different degree of virality. When coughing up in sputum, there may be streaks of blood after the damage to the integrity of the epithelium of the mucous membrane at the time of coughing.

At laryngoscopy, the mucous membrane is thinned, smooth, blistering, covered with viscous mucus and picks. Voice folds are thinned out. During phonation, they do not flash over the top, filling the gap with an oval shape, which can also have picks in enlightenment.

Likuvannya. Rational therapy includes the elimination of the causes of illness. It is necessary to turn off the hen, living in teasing hedgehogs. Slid to finish the voice mode. Three medicinal preparations are used to relieve phlegm, light urination: throat and inhalation with isotonic sodium chloride (200 ml) with addition of 5 drops of 10% tincture of iodine. procedures are carried out for

2 times a day, vicorist for a session of 30-50 ml per day, in three courses, stretching 5-6 strokes. Periodically prescribe inhalations of 1-2% menthol in oil. Olive oil menthol 1-2% can be poured into the throat every day for 10 days. To strengthen the activity of the salivary apparatus of the mucous membrane, 30% of the doses of potassium iodide, 8 drops, 3 times a day, in the middle, for 2 days, are prescribed (before admission, it is necessary to assess the tolerance to iodine).

In case of atrophic process, one hour in the larynx and nasopharynx, a good effect is given by submucosal infiltration in the biceps, and the back wall of the pharynx has a variety of novocaine and aloe (2 ml of 1% of novocaine with an addition of 2 ml of aloe). Warehouse іn'єktuyut pіd mucous membrane of the pharynx 2 ml at the skin side one hour. Infusions are repeated every 5-7 days; total 7-8 procedures.

4.6. HOSTRIUS I CHRONIC SLENOSIS

I TRACHE

Stenosis of the larynx and trachea appear at the sound of the air, as if passing through again in the lower wild ways, which lead to the insufficiency of the sound of the breath, expressed by the different world, right up to asphyxia.

Global manifestations with stenosis of the larynx and trachea are practically the same, likuvalni also come in similarly, to that it is possible to look at laryngeal and tracheal stenosis at once. Gostriy chi chronic stenosis of the larynx and trachea is not just a nosological entity, but a symptom complex of any kind of ailment of the distal pathways and areas adjacent to it. Tsya pathology can develop spontaneously or appropriately, accompanied by severe damage to the life of important functions of the dichal and cardiovascular systems, which require emergency help. Quite often, a call for help can bring an ailing person to death.

4.6.1. Hostile stenosis of the larynx and trachea

Hostile stenosis of the larynx is more frequent, lower stenosis of the trachea. More foldable anatomical and functional extension of the larynx, more open suture mesh and submucosal cell wall. Acutely ringing of the dyhal passages in the region of the larynx and trachea, causing a serious injury.

all the main functions of life security, right up to their full inclusion and death of the sick. Hostry stenosis vinikaє raptovo or porіvnjano a short interval of an hour, which, on the vіdmіnu vіd chronic, does not allow the organism to vibrate the attachment mechanisms.

The main clinical factors that influence non-gain medical assessment in acute stenosis of the larynx and trachea, є:

Steps of insufficiency of the sound breath;

The reaction of the body to sour starvation.

With stenosis of the larynx and trachea, they form attached(compensatory and zahisnі) that pathological mechanisms Hypoxia and hypercapnia are at the basis and quiet, and others lie, as they disrupt tissue trophism, including cerebral and nervous, which cause the chemoreceptors of the blood-bearing vessels of the upper dycal passages to wake up to excitation. Tse razdratuvannya is concentrated in the main branches of the central nervous system and as a reaction in the body, the mobilization of the reserves of the body is observed.

Suspension mechanisms may be less likely to form in case of acute development of stenosis, which can be reduced to complete paralysis of those other life functions.

Before the adhering reactions lie:

Dikhalni,

Hemodynamic,

Bloody;

Fabric.

Dikhalni they are manifested by a backside, which leads to an increase in legenev ventilation; zokrema vіdbuvaєtsya poblilennya chi more often dihannya, zaluchennya to vikonannya dyhalny act of appendage m'yazyv: back, shoulder girdle, shiї.

Before hemodynamic compensatory reactions include tachycardia, increased vascular tone, which increases blood volume in 4-5 times, speeds up blood flow, increases arterial pressure, removes blood from the blood depot. All this helps to revive the brain and the life of important organs, thereby changing the deficiency of sourness, improving the excretion of toxins, which caused stenosis of the larynx.

Blood'nimi and sudinnimi adhering reactions - mobilization of erythrocytes from the spleen, promotion of pro-

nights of the vessel and the hemoglobin buildup are more sour, worsening erythropoiesis. There is an increase in the density of the fabric of clay from the blood of the kiss, there is a frequent transition to the anaerobic type of exchange in clitins.

All these mechanisms can change hypoxemia (marriage sour in the blood), hypoxia (in tissues), as well as hypercapnia (increase in carbonic acid in the blood). Insufficiency of lung ventilation can be compensated for by washing up in the lung, whether there is a minimum volume of ventilation, which is individual for a skin ailment. An increase in stenosis, later, and hypoxia, in the minds leading to the progression of pathological reactions, the mechanical function of the left ventricle of the heart is disrupted, hypertension is manifested in a small number, the dyhal center is out of control, gas exchange is sharply disrupted. The cause is metabolic acidosis, partial pressure of acidity falls, oxidation processes decrease, hypoxia and hypercapnia are not compensated.

Etiological factors acute stenosis of the larynx and trachea can be both endogenous and exogenous. Middle of the first: mіstsevі fuses ill- swelling of the larynx and trachea, subfolding laryngitis, hostria laryngotracheobronchitis, chondroperichondritis of the larynx, laryngeal angina. Non-ignition processes- swelling, allergic reactions and others. Among the rest (exogenous), most often - third-party bodies, injuries of the larynx and trachea, after bronchoscopy, intubation. Zagalni ill organism- acute infectious diseases (cyr, diphtheria, scarlet fever), heart disease, sudin, nirok and others, endocrine disease.

clinic. The main symptom of acute stenosis of the larynx and trachea is the buttocks, noisy breathing. Fallen in the step of the sounding of the dyhal channels, at a glance, one can see the depression of the supraclavicular fossae, the retraction of the intercostal spaces, the disruption of the rhythm of the breath, which, due to the growth of the negative pressure in the middle cavity during inhalation. It is necessary to note that in case of stenosis on the throat, the back of the back is inspiratory in nature, the voice sounds like changes, and when the trachea is ringing, there is an expiratory back, the voice is not changed. In a sick person with a curved stenosis, there is a feeling of fear, rukhove zbudzhennya (wines throw, pragne flow), there is a hyperemia of appearance, drunkenness, heart activity is disrupted, secretory and motor func-

diya slunkovo-intestinal tract, sechovividna function of nirok. At times, the progression of stenosis is due to increased pulse rate, cyanosis of the lips, nose, and nails. Causes the accumulation of carbonic acid in the body.

Distinguish 4 stages of stenosis of the dichal passages:

I - compensation;

II - subcompensation;

III - decompensation;

IV - asphyxia (terminal stage).

IN stages of compensation vnaslіdok padіnnya naprugi CHIN in krovі posilyuєtsya dіyalnіst dihalnogo center, i, s іnshogo side, zbіlshennya vmіstu vuglekisloti in krovі Mauger bezposeredno dratuvati klіtini dihalnogo middle scho proyavlyaєtsya urіdzhennyam that pogliblennyam dihalnih ekskursіy shortening abo vipadannyam pauses mіzh vdihom that vidihom, zmenshennyam kіlkostі pulsіv. . The width of the vocal cavity is 5-6 mm. There is no breathing in a calm nestache, when walking physical ambition z'yavlyaєtsya ass.

IN stages of subcompensation manifestations of hypoxia are fading, there is a tension in the practice of the dichal center. Already in a calm state, there is an inspiratory back (difficulty in breathing) with inclusions before the act of breathing of additional m'yazyv, with which there is a retraction of the intercostal spaces, soft tissue of the jugular, as well as over- and subclavian fossae, inflation ( stridor (cloudiness of the outer coverings, restless camp of the sick. The width of the vocal fold is 4-5 mm.

IN stages of decompensation the stridor is even more pronounced, the tension of the wild muzzles becomes maximum. Dihannya becomes partly and superficially, ailments occupy the mind of a napіvsidyache stanishche, hands try to trim the back of the bed and other objects, which will improve the support for the additional dichal muscles. Larynx zdіysnyuє maximum excursions. Appearance of a bluish-blue color, feel like fear, cold sticky sweat, cyanosis of the lips, tip of the nose, nail phalanges, the pulse becomes part. The width of the vocal cavity is 2-3 mm.

IN stages of asphyxia with acute stenosis of the larynx, the breath is whistling, urivchaste, on the chest of Cheyne-Stokes. Incremental pauses between dichal cycles increase and sing together.

The width of the vocal fissure is 0-1 mm. There is a sharp fall in the heart activity, the pulse of parts, thread-like, arterial pressure does not show, the skins twist the pale-gray color for the spasm of the other arteries, the eyes expand. Sposterіgayutsya vtrata vіdomosti, exophthalmos, mimovilne séchovypkannya, defecation that suddenly comes death.

Diagnostics stenosis is based on the description of symptoms, data of indirect laryngoscopy, tracheobronchoscopy. It is necessary to explain the cause of that mist roztashuvannya zvuzhennya. For the recognition of laryngeal and tracheal stenosis, there is a low clinical sign. In case of laryngeal stenosis, it is more important to inhale, tobto. The back is inspiratory in nature, and in case of tracheal it is visible (expiratory type of back). The presence of a passage for breathing in the larynx calls out hoarseness, at that hour, as with a ringing trachea, the voice becomes clear. Differentiation of host stenosis followed by laryngospasm, bronchial asthma, uremia.

Celebration be carried out fallow in the cause of that stage of acute stenosis. When compensating and subcompensating stages, it is possible to stagnate drug treatment in the minds of a hospital. In case of swelling of the larynx, dehydration therapy, antihistamines, corticosteroid preparations are prescribed. In case of flare-ups in the larynx, antibiotic therapy is prescribed, anti-inflammatory treatment is prescribed. With diphtheria, for example, it is necessary to administer a specific anti-diphtheria serosa.

Most Effective Conducted drug destenosis - combinations of antihistamines, corticosteroids and dehydration drugs, the scheme of which was presented at the relevant divisions about the exaltation of the swollen larynx.

With decompensation stage stenosis required term tracheostomy, and at the stage of asphyxia the term is carried out conicotomy, and then tracheostomy.

When there are indications for goiter treatment, it is practical to perform surgery in any mind and without a call.

According to the distance to the isthmus of the thyroid gland in the fallow, they are divided into equal parts upper tracheotomy - over the isthmus

thyroid gland(Figure 4.12), lower under it and middle through the isthmus with frontal yoga roses and dressings. Slid designate that such a person was smart. As a rule, 2-3 pivkilts of the trachea are revealed.

More pleasantly, he fell fallow in the same way as the opening of the tracheal tubercle. With the upper tracheotomy, 2-3 rings are cut, with the middle 3-4 rings, and with the lower 4-5 rings.

Operation technique(Upper tracheotomy). The position of the ailing person should sound lying down, under the shoulders it is necessary to lay a roller, so that the larynx will bulge and ease the orientation. In some cases, with a pronounced stenosis, if the recumbent breathing becomes worse, it is necessary to perform the operation in a sitting or sitting position, heavy upheavals current asphyxia - navit without anesthesia. Anti-diarrheal medication: 1% novocaine from the house with a dose of adrenaline 1:1000 (1 drop per 5 ml). Promote the sublingual cyst, the thyroid gland and the hump of the cricoid cartilage. For orientation, you can use diamond green to indicate the middle line and rib of the cricoid cartilage. Vibrate the ball-and-socket opening of the skin and the subcutaneous tissue in the lower edge of the cricoid cartilage by 6 cm vertically to the bottom strictly along the middle line. Expand the superficial fascia, under which the white line appears - the place of the sternum-under-tongue m'yaziv. I’ll stop nadsіkayut and with a stupid path they’ll spread the m’yazi. When you look back at the isthmus of the thyroid gland, which may have a brown-red color and soft dotik. Then, along the lower edge of the cricoid cartilage, the capsule of the ridge expands, which fixes the isthmus, the rest swings down and becomes blunted with a blunt hook. Then the tracheal rings become visible, covering the fascia. Retained hemostasis is required up to the opening of the trachea. For fixation of the larynx, which is a significant turn in case of asphyxia, puncture the host horn near the thyroid and lingual membrane and fix the burn. In order to get rid of a strong cough in the trachea, inject 2-3% dikain through the neck of the sprat. Gostrokintsevy scalpel open 2 and 3 rings of the trachea. The scalpel must be inserted not too deep (0.5 cm),

Rice. 4.12. Tracheostomy:

a - the middle opening of the shkir and the opening of the edge of the wound; b - denudation of the trachea; c - rozsіchennya kіlets trachea; d - molding of the tracheostomy

so as not to injure the back, the cartilage was spared, the wall of the trachea and the front wall of the stravokhod lay down to it. The edges of the opening in the trachea are opened behind the help of a Trousseau expander and a tracheotomy tube is introduced into the tracheotomy tube, which is fixed behind the help of a gauze bandage on the neck.

In some cases, in children's practice with stenosis, vicarious diphtheria of the larynx and trachea, naso (oro) tracheal intubation is performed with a flexible tube made of synthetic material. Intubation is carried out under the control of direct laryngoscopy, її trivality is not guilty of overestimating 3 deb. As a necessary trival term for intubation, a tracheotomy is carried out, oscillators of the trivale of the endotracheal tube in the larynx are indicative of ischemia of the mucous membrane with a distant stenosis, scarring and persistent stenosis of the organ.

4.6.2. Chronic stenosis of the larynx and trachea

Chronic stenosis of the larynx and trachea - Trival progressive pathological ringing of the lumen of the larynx and trachea, which caused hypoxemia and hypoxia in the body. Stand, sound about the morphological changes in the larynx and trachea and the suicidal areas from it, sounding their light, developing properly for a rich hour.

Causes of chronic stenosis of the larynx and trachea are various. The most common ones are:

1) cicatricial process after surgical insertion and injuries or tracheal intubation (over 5 days);

2) benign and evil swelling of the larynx and trachea;

3) traumatic laryngitis, chondroperichondritis;

4) thermal and chemical optics of the larynx;

5) trivale of a third-party body in the larynx and trachea;

6) impaired function of the lower laryngeal nerves as a result of toxic neuritis, after strumectomy, pressure on the puffer and other;

7) congenital vadi, scar membrane of the larynx;

8) specific disease of the upper dical paths (tuberculosis, sclerosis, syphilis and others).

Northidko in the practitioner of the dilute of the chroni stenosis of Gundani is a matter of Tim, Shaho Tracheotomіya Vikonuzvazz Zubeye to Keeverae Methods of Operations: Deputy Other-third Kiltsi Trakheti Rosezazyuzhnoye, at the Tsomoy Trachetomi Tube Strike the lower edge of the Pispene cartilage, Shaho Schwidko Viklikaє Chondroperichond. Trivale of wearing a tracheotomy tube and її wrong choice can also cause chronic stenosis.

clinical picture lie down in the stage of sounding of the dyhal channels and that is the reason that caused the stenosis. Protefully and step by step, the growth of stenosis is given an hour at the development of adhering mechanisms to the body, which allows you to instill the insufficiency of the sound breath for the minds to improve the function of life safety. Chronic stenosis of the larynx and trachea negatively affects the whole organism, especially the childish one, which is associated with acid deficiency and snake reflex inflows, which emerge from the receptors, rotting at the upper respiratory paths.

Impairment of the respiratory tract led to sputum sputum and part of recurrent bronchitis and pneumonia, which in the terminal case lead to the development of chronic pneumonia with bronchiectasis. With a trivial overrun of chronic stenosis, changes in the cardiovascular system are brought to a halt.

Diagnostics ground on characteristic scargs, anamnesis and symptoms. The examination of the larynx to determine the nature and localization of stenosis is carried out for additional indirect and direct laryngoscopy, bronchoscopy and endoscopic methods, which allow to determine the level of the lesion, its width, the thickness of the scars, old look pathological process, the width of the glottis

Likuvannya. Small cicatricial changes that do not pereskodzhayut dyhannu, special likuvannya do not vymagayut, prote necessary guarding, shards in the old scar, yogo wrinkling and growth of stenosis. Cicatricial changes, which cause persistent stenosis, may lead to a reversible stenosis.

In case of severe indications, sometimes it is necessary to expand, stretch (booze) the larynx with bougies growing in diameter and special dilators with a stretch of 5-7 months. With a tendency to sound and inefficiency of trivalo dilatation, the lumen of the dyhal passages is inspired by a surgical path. Operative plastic insertions on the upper dichal passages vibrate, as a rule, in a different way and represent different options for laryngopharyngotracheofisuri. Qi operative vtruchanny folded at the vikonnі and may have a rich character.

4.7. Illness of the nerve apparatus of the larynx

In the middle of the disease of the nerve apparatus of the larynx, they are divided:

Sensitive

Dviguni.

Fallow in terms of localization of the main process of discord of innervation of the larynx, it can be central or peripheral movement, and, by nature, functional or organic.

4.7.1. Relax your sensitivity

The derangement of the sensitivity of the larynx can be caused by central (cortical) and peripheral causes. Central damage, caused, as a rule, by damage to the spivvіdnoshnâ protsessіv zbudzhennya and galvanization in the cerebral cortex, may be bilateral in nature. At the basis of damage to the sensitive innervation of the larynx lie neuro-psychic illness (hysteria, neurasthenia, functional neurosis, etc.). Hysteria, for I.P. Pavlov, as a result of the appearance of a greater nervous activity in people with a lack of good work of signaling systems, which manifests itself in the over-importance of the activity of the first signaling system and subcortex over the activity of another signaling system. Easily developed disorders of the function of the larynx, which viniclo under the influx of nervous shock, perelyaku, can fix, and ci discord can develop a trivial character. Damaged sensitivities appear hypothesia(reduced sensitivity) of varying vibrancy, right up to anesthesia, or hyperesthesia(with raised sensitivity), that parasthesia(To the side of sensibility).

Hypostesis, or anesthesia, the larynx is often more likely to occur in case of traumatic ear infections of the larynx or the upper laryngeal nerve, in case of surgical interventions on the organs of the throat, diphtheria, anaerobic infections. Decreased sensitivity of the larynx to ring out inconspicuously subjectively in the appearance of the throat, handlessness in the throat, dysphonia. However, a decrease in the sensitivity of the reflexogenic zones of the larynx leads to the inability to catch shmatochkіv їzhі and rіdini in the dychalny tract and, as a result, a development of aspiration pneumonia, damage to the respiratory tract, right up to asphyxiation.

Hyperesthesia may be of different variability and accompany ailing symptoms in case of diarrhea and illness, often due to the need for mucus exhalation. With hyperesthesia, it becomes difficult to look at the oropharynx and larynx through the vomiting reflex.

Paresthesia is manifested by the most suggestive sensations, like a tingling, liver, visualization of a third-party body in the larynx, spasm of the skin.

Diagnostics Based on the data of anamnesis, sickness scars and laryngoscopy picture. Diagnostics can get stuck

method for assessing the sensitivity of the larynx during probing: torsion of the mucosal wall of the laryngopharynx with a probe with cotton wool reveals a positive reaction in the patient. Instruction from the necessary consultation of a neuropathologist, psychotherapist.

Celebration carried out together with a neurologist. Shards in the basis of maladjustment of sensitivity lie in the destruction of the central nervous system, likuvalni go straight to the liquidation. Sedative therapy, coniferous baths, vitamin therapy, spa treatments are prescribed. In some cases, effective novocaine blockades, like in the expansion of nerve nodes, and along the pathways. From physiotherapeutic measures in case of peripheral lesions, internal galvanization and holcoreflexotherapy are prescribed.

4.7.2. Dviguni

Movements of the larynx derangement appear as a partial (paresis) of a general (paralysis) impairment of functions. Such damage can be caused as a result of the ignition and regenerative processes, both in the larynx, and in the laryngeal nerves. stink can booty central and peripheral hike. Separate myogenic and neurogenic paresis and paralysis.

Central (cortical) paralysis the larynx develops with craniocerebral injuries, intracranial hemorrhages, multiple sclerosis, syphilis; can be of a one-sided or two-sided character. Paralysis of the central tremor is often associated with lesions of the dovegasy brain, and may be combined with paralysis of the lower limbs. Peripheral paralysis and paresis of the larynx associated with subcutaneous nerve pathways in the expansion of the thoracic cavity (injuries, swelling, abscesses).

Clinical symptoms they are characterized by discords of mov, іnodi dihannya, they can be accompanied by courts. The motors of the central movement often develop in the last stage of important brain damage, for which it is important to develop.

Diagnostics based on the characteristic symptoms of the underlying illness. With indirect laryngoscopy, one or both halves of the larynx are damaged.

Celebration straightened out the usunennya of the main ailment. Mіstsevі razladi vglyadі difficulty breathing іnоdі vymagayut.

yut surgical insertion (tracheostomy is viroblyayutsya). In some cases, it is possible to stagnate physiotherapy in the presence of electrophoresis of medicinal preparations and electrical stimulation of the larynx. A pleasant effect may be climatic and phonopedic exuberance.

Peripheral paralysis of the larynx, As a rule, unilateral and comminuted damage to the innervation of the upper larynx and mainly to the sigmoid nerve, which is explained by the topography and the presence of these nerves with the richness of the organs of the breast and thoracic emptying, which can lead to impaired nerve function.

Paralysis of the upper laryngeal and scrotal nerves, mostly with tufts in the stravokhod and in the middle, with increased peribronchial and mediastinal lymph nodes, syphilis, cicatricial changes in the region of the upper leg. With diphtheria neuritis, paralysis of the larynx is accompanied by paralysis of the pharynx. Causes of paralysis of the swivel nerve can be aneurysm of the aortic arch for the left nerve and an aneurysm of the right subclavian artery for the right swivel nerve, and induce surgical intervention. The left swivel nerve is most often affected, zocrema during strumectomy or swelling in the middle area

clinic. Hoarseness and weakness of the voice of varying variability are characteristic functional symptoms of paralysis of the larynx. With bilateral paralysis of the turning nerves, stenosis of the larynx is caused, fragments of the voice folds break at the middle station and collapse, then the voice becomes sonorous.

At laryngoscopy, characteristic damage to the friability of the arytenoid cartilage and the vocal folds is seen as a fallow stage of the ruddy folds. In the early stage of unilateral paresis of the sigmoid nerve, the vocal fold becomes somewhat shortened, but it retains the fringed friability, receding into the middle line when inhaled. At the advancing stage, the vocal fold on the side of the blow becomes unbreakable and fixes in the middle position, which is the name of the corpse camp. There is a compensation from the side of the protilazhny vocal fold, as it approaches the vocal fold of the protilazhny side, so that a voice sounds with a slight hoarseness.

Diagnostics. In case of damage to the innervation of the larynx, it is necessary to identify the cause of the illness. X-ray follow-up and computer tomography of the chest organs with a method of revealing a volumetric process are carried out. For the inclusion of syphilitic neuritis, it is necessary to continue the blood for Wasserman. Vocal fold paralysis, which is accompanied by spontaneous rotatory nystagmus on one side, is indicative of damage to the bulbar part of the dougestary brain.

Celebration in case of rukhovy paralysis of the larynx, the therapy of causative disease was directed. In case of paralysis of ignition etiology, anti-seizure therapy, physiotherapy procedures are carried out. With toxic neuritis, for example, with syphilis, specific therapy is carried out. Stains of damage to the frivolity of the larynx, vibrating with puffs and cicatricial processes, rejoice promptly. Efficient plastic surgery - removal of one vocal fold, replacement of the vocal folds and others. With bilateral paralysis of the larynx, stage III stenosis occurs, which will require an emergency tracheostomy.

Myopathic paralysis bumovlenі razhennyam m'yazіv larynx. With myopathic paralysis, the sounding of the larynx is affected. The most feared is vocal paralysis. With bilateral paralysis, tsikh m'yazіv pіd h background

Rice. 4.13. Move the larynx apart:

tsії mizh folds are tucked into an oval shape of the gap (Fig. 4.13 a). The paralysis of the transverse intercranial mass is laryngoscopically characterized by the opening in the posterior third of the glottis, the space of the trident form for the rahuno, which, in case of paralysis of the intervertebral mass, of the body of the arytenoid cartilages does not converge to the middle line. Strike the bіchnyh cricoid-shaped m'yazіv to the point where the voice gap swells into the shape of a rhombus.

Diagnostics Based on the data of anamnesis and laryngoscopy picture.

Celebration straight-forward to the cause, which called out paralysis of the laryngeal m'yaziv. Mistsevo zastosovuyt physiotherapeutic procedures (electronic bathing), holcoreflexotherapy, sparing food and voice regimens. To improve the tone of the larynx, a positive effect can be faradization and vibromassage, as well as phonopedic exaltation, with the help of special sound and dyhal rights, or improve the dyhal functions of the larynx.

laryngospasm - convulsive ringing of the voice box, from which take the fate of all the troubles of the larynx; zustrіchaetsya most often in a child's vіtsі. The cause of laryngospasm is hypocalcemia, lack of vitamin in the presence of calcium in the blood decreases to 6-7 mg% instead of the normal 9.5-11 mg%. Laryngospasm may be hysteroid in nature.

clinic. Laryngospasm sounds like a raptovo following a strong cough, a flutter. On the back of the head, there is a galaslivy, nervous trivalium in the breath, which changes in part of the superficial breath. The child's head is thrown back, the eyes are wide open, the skin is tense, the skin is cyanotic. They can appear as judges of kіntsіvok, m'yazіv guise. After 10-20 s, the dyhal reflex is confirmed. In a few moments, an attack can end in death as a result of a spike in the heart activity. At the connection with the advanced m'yazovy zbudlivistyu, it is possible to operatively insert: adenotomy, roztin of the pharyngeal abscess and in; in such children, laryngospasm is associated with complications.

Diagnostics. Spasm of the vocal tract is known on the basis of the clinic attack and the presence of any changes in the larynx in the inter-attack period. At the moment of attack with direct laryngoscopy, it is possible to burn the epiglottis, scooped

these folds converge along the middle line, arytenoid cartilages are close to the wyverns.

Likuvannya. Laryngospasm can be eliminated, be a strong mimic of the trigeminal nerve: a prick, a pinch, pressing on the root of the tongue with a spatula, squeezing it with cold water and then. In case of crippling spasms, 0.5% novocaine is administered intravenously.

In dangerous cases, it is possible to go as far as tracheotomy or conicotomy.

In the post-attack period, they are prescribed chronic therapy, calcium preparations, vitamins, and refreshment on a fresh face. For the last century (sound up to five rokiv), the appearances are usuvayutsya.

4.8. INJURIES OF THE LAINT AND TRACHE

Injuries of the larynx and trachea in the fall due to the auricular factor can be mechanical, thermal, changing and chemical.

Injuries of the larynx and trachea in the hour of peace streak unequally rarely. The stinks are subscribing to open and close.

Vіdkritі trauma or wounded larynx and trachea, as a rule, they have a combination character: the ears are not only wet in the throat, but also the organs, skin, chest cells. They cut the cuts, stab those fire wounds. Rіzanі rani blamed on the naslednija zavdannya poshkodennya with different rіzhuchy shells. Most often they are applied with a knife and a razor with the method of driving in self-destruction (suicide). For equal rozashuvannya rozryza rozryznyayut:

1) the wound, which is located under the sublingual cyst, if the shield-and-lingual membrane is cut;

In the first episode, there is a short cut of the wound, as a rule, it is wide, the wounds of which you can look through her throat and part of the pharynx. The epiglottis in case of such wounds, it starts to burn, the breath and the voice are saved, but when the wound is sore, it’s the day, so it’s like the rose of the larynx comes out of the articulatory apparatus. Like in such a time, destroy the edges of the wound, close the cim її enlightenment, the language is inspired. When forging hedgehogs, it will come out of the name through the wound.

clinic. The burning camp of the sickly significant world is being destroyed. The blood pressure falls, the pulse quickens, the body temperature rises. When the thyroid slough is injured, bleeding is significant. Svіdomіst zalezhno vіd step that nature of injury can be saved or swindled. When the carotid arteries are injured, death comes at once. Proteo sleepy arteries with suicidal injuries rarely twitch; self-pliers strongly throw their heads back, spitting out, the arteries at the same time squeezing the back and do not jut out.

Diagnostics do not become difficult. It is necessary to prescribe the cost of wound dressing. Looking through the wound, that probing allows you to identify the cartilaginous skeleton of the larynx, the appearance of a swollen, bloody.

Celebration surgery, including bleeding, provision of adequate breathing, hemorrhage and primary wound healing. I would like to pay special attention to the following work on the distal function. As a rule, a tracheostomy is performed (lower bazhan).

As if the wound was opened in the gap of the shield-and-lingual membrane, then the wound was sutured in a ball-and-socket manner from the obov'yazykovym larynx to the subtongue brush with chrome-plated catgut. Before suturing the wound, it is necessary to resolutely bleed with a path of bandaging the vessels. In order to change the tightness and secure the closeness of the edge of the wound, the head of an ailing person is put on stitches before the front. In case of gradual deformity of the walls of the larynx, it is possible to shrug, suturing, molding laryngostomy and inserting a T-like tube. Eating a sick person with a method of infecting an infection is safe for the help of a shunt probe, which is introduced through a nis abor. At the same time, anti-inflammatory drugs are prescribed, which include the introduction of massive doses of antibiotics, antihistamines, detoxification drugs, hemostatics, anti-shock therapy.

Inflamed laryngeal ear and trachea are rarely isolated. Most often, stinks are combined with the pharynx, stravohod, thyroid follicle, vessels and nerves of the neck, ridge, spinal cord and brain.

Inflamed wounds of the larynx and trachea are divided into stitched, slipped, dotted (tangential).

With a scratchy wound, open two - the entrance and the exit. It is necessary to protect that the inlet opening is rarely ziggaetsya with the course of the wound channel, the laryngeal cavity and the outer opening, the shards of skin and tissue on the neck are easily squeezed.

With blind wounds, the tricks of the chi kul get stuck at the larynx and the soft tissues of the neck. Drinking in empty organs - the larynx, trachea, stravochid - the stench can be provoked, spitting or aspirated from the bronchi.

With dotichnyh (tangential) injuries, the soft tissue of the neck is affected, without damaging the integrity of the mucous membrane of the larynx, trachea, stravohod.

Clinic lie in the depths of the depths, step, in view of the forward force of the projectile to injure. The severity of the injury may not be consistent with the magnitude and strength of the projectile to injure, so as a concomitant concussion to the organ, damage to the integrity of the skeleton, a hematoma and swelling of the internal vistilka, the camp of the ailing will be overcome.

Injured people often get hurt in an unknown state, shock is often expected, shards are injured by a blazing and sympathetic nerve, and moreover, when great vessels are injured, blood loss is great. There may be a more permanent symptom - difficulty in breathing due to poor health and pressure on the respiratory pathways and hematoma. Emphysema is blamed for quiet depressions, if the early opening of small roses and fast zlipaetsya. Forging is always destroyed and is accompanied severe pain, hedgehog, trapplyayuchi in the distal paths, spriya viniknennuyu cough and development of the incendiary complication in the lung.

Diagnosticsґruntuєtsya on data anamnesis and look around. Shiyna wound of the big one is wide, with ripped edges, with a significant insertion of tissue and the presence of third-party bodies.

metal ulamkiv, shmatochkiv fabrics, particles of gunpowder in wounds and in. When wounded on the near edge of the wound, it was singed, near it it was bloody. Some of the wounded show emphysema of the soft tissues, as evidence of the penetration of the wound into the empty throat or trachea. About tse can evidence and hemoptysis.

Laryngoscopy (direct and indirect) in a wounded person is often practically unavoidable due to severe sickness, impossibility of opening the mouth, fractures of the slit, sublingual cyst, etc. In the coming days, with laryngoscopy, it is necessary to designate the area in front of the larynx, the vocal fold, and the vocal space. Demonstrate hematomas, open the mucous membrane, shrink the cartilaginous larynx, the width of the glottis.

Informative in diagnostics, the X-ray method of follow-up, given by computer tomography, for the help of which it is possible to identify the skeleton of the larynx, trachea, the presence and localization of third-party bodies.

Celebration in case of fire injuries, two groups of entries are included:

1) recovery of breathing, bleeding, primary wound healing, fight against shock;

2) carrying out antiseptic, desensitizing, deep-seated therapy, antipruritic (maybe other) cleavage.

For the restoration of dyhannya and prevention of further damage to the dyhal function, as a rule, a tracheotomy is performed with the formation of a tracheostomy.

Bleeding is to be applied to the ligatures on the vessels in the wound, and in the case of large vessels, the bandaging of the outer carotid artery is carried out.

The fight against pain shock, the supply of narcotic analgesics, the transfusion therapy, the transfusion of monogroup blood; take care of your heart.

Primary surgical treatment of wounds, cream of bleeding, including rupture of soft tissues, to spare, removal of third-party bodies. With a large sore throat, a laryngostomy should be formed with the introduction of a T-like tube. In case of emergency calls, it is necessary to send for the scheme

protipravtsevu syrovatka (as before, before the operation, sirovatka was not introduced).

Another group of entry includes the recognition of broad-spectrum antibiotics, antihistamines, dehydration and corticosteroid therapy. Livelihood of ailments is carried out through a nasopharyngeal probe. With the introduction of the probe, be careful not to get yoga in the dychal passages, which indicates a cough, difficulty in breathing.

Closed by injuries of the larynx and trachea blamed when hit by other third-party bodies at the empty larynx and sub-voice space. Often the mucous membrane of the throat is injured by a laryngoscope or an endotracheal tube when giving anesthesia. There are wounds, bleeding, damage to the integrity of the mucous membrane in the area of ​​the wound. Sometimes in the field of injury, that kind of a navlyaetsya nabryak, which can expand, and even become a threat to life. If you get an infection at home, you can get purulent infiltrate, do not include the possibility of development of phlegmon and chondroperichondritis of the larynx.

With a trivial (more than 3 days) or rough injection of the endotracheal tube on the mucosa, the so-called endotracheal granuloma is settled for an hour. The most common place for rotting is the outer edge of the vocal fold, because in this place the tube is most intimately in contact with the mucous membrane.

clinic. In case of closed injury of the mucosal membrane of the throat and trachea, an external body causes a sharp pain, which is exacerbated by coughing. Sooner or later, tissue infiltration develops, which can lead to difficulty in breathing. Through the sharp pain of seeing ailments, you can’t shove a slip, take a hedgehog. The arrival of a secondary infection is characterized by the appearance of illness on palpation of the neck, increased coughing and pain when the body temperature rises. In severe blunt trauma, swelling of the soft tissues of the larynx and swelling of the mucous membrane is most often seen in the vestibular tract.

Diagnostics is formed from the anamnesis and objective methods of follow-up. With a laryngoscope examination, one can notice swelling, hematoma, infiltrate and abscesses in the area of ​​injury. The pear-shaped sinus or vallecule on the side of the lesions may accumulate.

this slea looks like a "lake". Radiography in direct and lateral projections, as well as with different contrast preparations, allows in some cases to reveal a third-party body, indicating the rіvennі razhennja.

Likuvannya. The tactic of managing the sick is to lie down in view of the sight of the sick, the nature of that flat area of ​​the mucus membrane, the lumen of the dyhal paths, the width of the vocal chin and the other. For the presence of an abscess, it is necessary to work it up with a laryngeal (attachment) scalpel after anterior application of anesthesia. In case of dyspnea disorders (stenosis II-III stage), an emergency tracheostomy is necessary.

In case of rupture, for liquidation of stenosis, medical destenosis treatment (corticosteroids, antihistamines, dehydration preparations) is prescribed.

In all types of closed injuries of the larynx that occur against the background of a secondary infection, antibacterial therapy, antihistamines and detoxification diseases are required.

4.9. CHONDROPERICHONDRITIS OF THE LAINT

chondroperichondritis (hondroperihondritis) - inflammation of the perichondrium and cartilaginous larynx. The first, as a rule, affects the perichondrium, the next hour the ignition process is irradiated and the cartilage. Clinically different hostryі chronic chondroperichondritis, and rottenі sclerosing(fibrosis) yogo form. The purulent form develops during injuries, infectious processes, which sclerosis develops during chronic inflammatory processes, which end with secondary cicatricial (fibrous) changes.

Etiology. One of the most common etiological factors in chondroperichondritis is trauma. At the hour of war, they suffer from fire injuries, at peaceful times - cuts, stabs, blunt earaches of the larynx, in which the cartilage is hurt and the infection penetrates. Inflammation of the cartilaginous larynx can also be blamed on the collapse of the mucous membrane of the larynx during bronchoscopy, during the stravohod, after intubation and tracheotomy.

In a number of cases, after promenotherapy, with blastomatous processes, early or late laryngeal chondroperichondritis can be blamed.

Inflammation of the perichondrium and cartilage in case of infectious diseases (tonsillitis, beshikhov inflammation, typhoid) can be contact and hematogenous way.

With tubercular infections, those infiltrates that penetrate to the perichondrium and cartilage can develop both specific and non-specific chondroperichondritis on the ground of a secondary infection.

clinic. Clinical manifestation of chondroperichondritis of the larynx to lie in terms of etiology and localization. Sounds inflamed cartilage plate becomes hard, sickly on palpation, due to infection of soft tissues. With laryngoscopy, there are signs of infiltration and sagging of the mucous membrane, which sounds like a clearing of the larynx. Breaking the disease, as a rule, is trivial, it can take a few months and end with cartilage necrosis.

Chondroperichondritis of the thyroid cartilage characterized by the appearance of painful hard-elastic swelling in the projection area of ​​the cartilage on the side of the injury. The skin at the inflamed area is hyperemic, sweaty, the cervical lymph nodes are enlarged. With laryngoscopy, changes from the side of the mucous membrane may be indicated. Damage to the inner side of the thyroid cartilage is accompanied by swelling of the mucous membrane, here it is hyperemic and swollen. As a rule, the scaly-epiglottic fold takes the fate of the inflamed. The fuse infiltrate can cover the voice gap and call the vein.

With chondroperichondritis of the epiglottis vinikaє rіzke yogo sweating, rigidity, swelling that іnfіltratsija often beyond the laryngeal surface. For such a camp, choking occurs during forging with the help of eating parts of the larynx. Pain symptoms are especially pronounced in lesions of the arytenoid cartilage. In this depression, the area of ​​the affected cartilage becomes similar to a sack. The bulge can extend to the scoop-epiglottic fold, the pear-like sinus, with which the dichal function of the voice is disrupted.

With inflammation of the cricoid cartilage the process of localization in the sub-voice space, de є klіtkovina. In this area, there is a pronounced ringing of the lumen of the larynx, as a result of which the dichal function is destroyed. For liquidation of stenosis, a term tracheostomy is needed.

Inflammation of the cricoid cartilage occurs after tracheotomy, if the tracheotomy tube is attached to the lower edge of the cricoid cartilage and trauma.

With damage to all cartilage of the larynx due to hyperemia, swelling of the soft tissues of the larynx. There is a sharp sound at the throat, at the anterior commissure granulation, a fistula are often seen, which is seen as rot. When irradiated to the ignition process of the tissues of the laryngopharynx, the patient's head becomes immobilized.

The development of symptoms is accompanied by a severe intoxication of the body, an increase in body temperature to febrile numbers.

Diagnostics Based on the data of anamnesis, examination of the patient, instrumental, radiological and endoscopic methods of follow-up. Indirect laryngoscopy, which always comes into play with pronounced inflammation of the cartilaginous larynx. It is necessary to differentiate from acute thyroiditis, paresis and paralysis of the larynx, rheumatic ankyloses of the subglottis of the larynx.

Likuvannya. With acute chondroperichondritis of the larynx, antiseptic therapy is prescribed; antibiotics (cefazolin, caten, augmentin, sumamed, tarivid and in.), sulfa drugs, antihistamines (claritin, fencarol and іn), detoxification therapy, analgesics, symptomatic diseases.

Treatment of chondroperichondritis of the cricoid cartilage, which is due to tracheotomy at the ligament with a squeeze on the cartilage of the tracheotomy tube, it is necessary to start by moving the tracheostomy and larger lower trachea.

With the method of increasing the general reactivity of the body, autohemotherapy, biostimulants, and vitamin therapy are indicated.

Nadal, if the symptoms subside, physiotherapeutic injections are recommended (UHF, laser therapy, phonoelectrophoresis with antiseptic drugs, electrophoresis with potassium iodide, calcium chloride, etc.).

At the same time, the abscess is shown to have surgical insertion with the method of exposing the abscess and removing the necrotic tissues. The appearance of the burrow is also indicated before the operation, as it is vykonuetsya with a method of roztin that drainage of the burr.

Choose the method of surgical insertion to lie down according to the nature, localization, breadth of the process. In case of internal perichondritis, endolaryngeal operations can be started, in case of ovarian perichondritis, an endolaryngeal surgical procedure is required. The wide-width nabula is completed (slisic) fenestration of the larynx as a sparing method of draining purulent inflammation of the cartilaginous larynx. In cases of persistent stenosis of the dichal passages, an anterior tracheo or laryngostomy is necessary.

Forecast. Illness can be severe. In the early stage of the disease, the efficiency of lust is the greatest. With purulent lesions, the prognosis of life is favorable, proteosumnivny at a glance of the complete restoration of the functions of the larynx.

4.10. FOREIGN THILAS OF THE LANNY, TRACHE AND BRONCHIV

The sage is more unique in sickness, vibiratime koshti against them.

T. More

Third-party bodies of the larynx, trachea and bronchi are often narrowed, more often in children, which is associated with insufficiently developed reflexes. Third-party bodies can be like other objects: fruit tassels, grains, coins, other parts of toys, buttons, hairpins, etc. In older adults, the third body is consumed in the dychal way more often for alcoholic sleep. It is possible to get into the distal pathways of dentures, shmatochkіv їzhi, vomit mast and іn.

Side bodies that have been consumed in the distal paths do not sound like coughing. At the same time, as an object slips through the vocal fold, there is a reflex spasm and the vocal folds are strongly zigzag. In a number of depressions, a third-party body can either penetrate into the wall of the trachea, or linger in the veins of enlightenment. When inhaled, the outer body directs more and passes more often near the right bronchus, the shards remain broader behind the left bronchus and are practically extended to the trachea.

Clinical picture. To fall into the river of stagnation, the degree of obturation of the dyhal channels and the nature of the third-party body. With the introduction of a third-party body into the wall of the throat, there is a turbulence, the chest is felt in the throat, a cough, a broken bowel.

Small objects can penetrate the bronchi, calling out obstruction. The rest can be three views:

Naskrizna;

Ventilated;

At squinted looking a third-party object often fills the lumen of the bronchus and does not reveal the manifestations of dycal disturbances. At valve blockages can be swallowed up in the leg when inhaled, prote when seen, the lumen of the bronchus sounds loudly and the outside body is strongly obturating the respiratory path. As a result of such dyhannia, the number of times in the lung gradually increases and develops emphysema. Nareshti, at re-blockage There is an obstructive atelectasis of the singal segment of the leg in the dychal path.

Gostrі, thin external bodies can wedge into the wall of the larynx or trachea, causing cough and pronounced pain symptoms. Nadal in the area of ​​stagnation, the igniting process can develop and in the same depressions - sclerosis with a further encapsulation of a third-party body.

An important sign of a third-party body of the trachea is a symptom of caressing (baloting), as if hanging behind the help of a phonendoscope on the chest wall. Vіn vinikaє in case of cough reflex under the impact of a third-party body on the lower surface of the vocal folds. Another important sign is a cough, which is attack-like and accompanied by cyanosis.

Diagnostics Based on anamnesis data, instrumental follow-up of the larynx. In case of obstruction of the bronchus, it is necessary to conduct auscultation of the leg, take a dichal excursion of both halves of the chest during a visual examination. Obov'yaskovym - X-ray follow-up of a sick person, when indicated - tracheobronchoscopy.

Likuvannya. Some third-party body goes in for help with direct laryngoscopy. Due to the presence of a third-party object in the trachea and bronchi, it is possible to vibrate through the natural pathways - an upper tracheobronchoscopy is performed due to chronic anesthesia. With deep zalyagannі and trivial perebuvanni third-party

the body, pronouncedly damaged ovnishny breath, and in case of recent tests of upper bronchoscopy, the term tracheotomy is viable. A little further, try to see a third-party object through the tracheotomy opening, tobto. lower tracheobronchoscopy.

4.11. OPTICS OF THE LARNOOTH AND TRACHEA

The larynx and trachea are of two types:

Thermal

Chemistry.

Thermal optics blamed for vipadkovy prokuvannya hot rіdin (water, milk and іn), getting into the mouth of a bet, hot wind. In case of thermal opiums, one hour at a time suffer in disguise, the eyes of that other worker of the body, which scorched the burning camp.

Chemical Optics blame in the aftermath of forging or inhalation of concentrated chemical compositions. Three acids of the most important opium cause sirchan, hydrochloric, nitric, chromic. The vestibular part of the larynx is most often affected (epiglottis, aryepiglottic and vestibular folds, arytenoid cartilage). At the point of contact of the chemical agent with the mucosal membrane, the resulting opiate reaction of the tissue appears to be hyperemic, in addition, a fibrinous coating is established.

clinic. Perebіg opіkіv vіdіznyаєє zalezhny vіd їkhny step, localіzії protsessі, I'll become a stalker organism.

Stage I opiates are characterized by uneven whitening of the mucous membrane with a distant hyperemia and desquamation of the epithelium. There is no severe intoxication to the body. Starting from the third day, the removal of the whitened superficial balls of the epithelium with exposed hyperemic tissue begins.

In case of stage II opiates, intoxication to the organism is pronounced, on the mucous membranes there is a different length of epidermal ruptures, opioid bullae with transudate. On the 7th-8th day, the epidermis is broken down with erosions, so that it practically burns without scarring.

In stage III opiku, intoxication is especially severe, є tissue necrosis with mitosis, granulation with distant scarring and arrosive bleeding.

Without a hitch on the lips, mucous membranes of the empty mouth and pharynx are characteristic of the opium. The ailing person is afraid of pain, it looks like a liver, sleeting, attack vomit and cough from the backside and feel badly. Difficulty breathing is accompanied by a change of voice to Athos. The pain symptomatology is aggravated by cold and cough ruhi. Stage III surgeries, as a rule, are accompanied by lesions and parenchymal organs, which are the cause of the death of the sick person.

Diagnostics Based on the data of the anamnesis, rozpovidi eyewitnesses, characteristic data of looking around, following the opik, the hour that passed the opik. Sometimes in the first year, speech, which called opik, is recognized by the smell of the mouth, characteristic of opikiv with octic acid, ammonia, phenol and іn. For a ship-medical visnovka, it is important that the speech that called the opik could be marked in the first year after the opik. Already on the other side, the pits and their water-creams are scorched with specific rice. From the first years of illness, control over the camp of nirok, liver is carried out.

Celebration(Div. ops to the stravokhod) may rozpochatisa negainno opіku. It is necessary to wash the hose with roses to neutralize it. When opіka meadows, wash the wort and the shell with 3-4 flasks of table otstu or lemon juice diluted halfway with water. In case of acid opiates, water is stagnant with addition of magnesium carbonate, far soda (sodium bicarbonate). For the presence of the necessary medicines for rinsing the empty mouth and pharynx, rinsing the drain of the vicorist, water is added with half the amount of milk and white eggs (10-15 pieces). The amount of native land, which is victorious for washing, can be significant - 3-4 liters.

From the first day, the patient is prescribed adequate analgesics, broad-spectrum antibiotics, corticosteroid drugs, heart drugs, and symptomatic diseases. Taking zhі through the mouth in a sick person with severe difficulties, it is necessary for him to take parenteral ingestion, live enemas. Massive transfusion therapy, transfusion of blood preparations are prescribed for the fight against streaks.

With the growth of the buttocks, a tracheotomy is required. For the prevention of concomitant cicatricial processes, the stravokhod is shown a trivale of buzhuvannya.

Forecast in light moods it is accommodating. In important situations, if the acid is concentrated and the meadow is drunk to the drain, the death of the sick person due to nirk deficiency lasts for many days.

In ailments, ailments develop great scarring stenosis of the pharynx, larynx, stravohod, yak require trival likuvannya, surgical stenosis.

4.12. FOREIGN TYLA ZHOVODA

The consumption of third-party bodies in stravochids has a predominantly vipadical character: at once from a rotten hedgehog, with an unpreserved, quick hedgehog. You can take away the teeth and wearing dentures, alcohol consumption, shkidlivy zvichki - priming flowers, heads, coins with your teeth. Navmisno third-party bodies can be wrapped in mentally ill people.

The nature of third-party objects can be the most manipulative: ribs, bird brushes, meat pieces, coins, toys, dentures, etc.

Third-party bodies get stuck at the walker in the areas of physiological sounds, most often neck ringing. The tensed transversely swarthy musculature confuses the stravokhod with a strong reflex reflex. Another place for the frequency of stuck third-party phone loans chest baby i, nareshti, third - cardiac.

Clinic in case of third-party bodies, the stravokhod is determined by its size, surface topography, level and staggering according to the length of the stravokhod. A sickly turbulent bіl behind the sternum, which is being strengthened under the hour of forging їzhi, and also in the presence of a third-party body. In some vipads, the passage of hedgehogs is broken. The camping of the tulub is characteristic: the head hangs forward, turns at the same time from the tulub, in the eyes of a viraz perelak. The camp of the ailing might be destroyed.

Diagnostics. Obstezhennya slid rozpochinati z looking around the laryngopharynx. Other third-party body can opine in the lower umbilical cords, the roots of the tongue, in the pear-like sinus.

With indirect laryngoscopy, it is possible to reveal an important sign of a third-party body, or injuries in the first ringing.

water - skupchennya stony slip in pear-like sinus on the side of the lesion. It is possible to watch for swelling and infiltration of the arytenoid cartilage. When pressing on the throat or trachea, sometimes pain is indicated.

Informative X-ray report to the stravohod with contrast, which allows to reveal as third-party objects, and sound like a blockage to the stravokhod. Due to the obvious perforation of the stravohod, vicious lateral body, radiography can show aggregation again in the supraesophageal cell in the appearance of light patches between the ridge and the posterior wall of the lower pharynx. Clotting of the mediastinal contrast mass, which is seen on radiography, is also a sign of perforation.

Residual visnovnist about the presence of a third-party body and yogo characteristic gives the conduct of esophagoscopy to the tests of bronchoesophagoscopy of Brunings, Mezrin, Friedel, flexible fiberscopes.

Likuvannya. Esophagoscopy is the main method of reaching the stravokhod and remote third-party bodies. The technique of conducting esophagoscopy is described in the section “Methods for the follow-up of ENT organs”.

Complicated. A hostile object, wedged at the wall of the stravokhod, causing damage to the integrity of the mucous membrane and infection. Vinykla infiltration suffocates the m'yazovu wall of the grass walker, and then, perhaps, the cell wall of the middle wall. The shards of the wall of the stravokhod do not look like a capsule or fascia, but are honed only with a cellular tissue, external bodies can often cause a sharp perforation with an insufficient development of mediastinitis. As perforation occurred at the upper vents of the stravokhod, on the shii there is an emphysema and crepitation of soft tissues.

Purulent periesophagitis and mediastinitis, during the first year of positive dynamics against the background of massive antiseptic therapy, indications before surgical insertion and drainage of the navco-stravochid cell tissue, as in the fallow in the same time, the injury to the stravokhod can be taraccal.