Chronic Laryngeal Stenosis
Chronic laryngeal stenosis is a diminution in the size of the airway through the larynx, due to formation of scar tissue and adhesions in the larynx as a result of trauma or disease. The same condition may occur immediately below the larynx in the upper end of the trachea. According to Chevalier Jackson1 75 to 85 per cent of his cases are the result of high tracheotomy. For years he and his many followers have emphasized the importance of placing the tracheotomy tube as low in the neck, and consequently as far from the laryngeal structures, as possible. If circumstances should demand a fairly high emergency tracheotomy, this should be changed to a low tracheotomy as soon as the patient can reach a properly equipped operating room. Even in a dire emergency, however, one can make the opening in the trachea well below the danger level by using Jackson's technic. Other traumatic causes are external injuries and wounds of the larynx and the effect of unrecognized foreign bodies in the larynx. Chronic laryngeal stenosis may also be produced by ulcerative laryngitis, diphtheria, perichondritis, syphilis, or tuberculosis.
At one time treatment entailed repeated and more or less forceful dilatations over a prolonged period of time. Unless the dilatations were continued, the dilated lumen subsequently contracted to its former inadequate size. The patient was forced to continue wearing a tracheotomy tube.2, 3
The endolaryngeal method was greatly advanced by the development of the soft rubber, core molds of Jackson.1,4 Even this required a. . .