[Surgical treatment of children with cicatricial stenoses of the larynx and trachea].

The present authors recommend a modification of Ivanov's method suggested by their treatment of 41 children, aged 4 to 15 years; 12 patients suffered from stenosis and 29 patients from atresia of the larynx and trachea, which resulted from surgical intervention required by the complications of extended nasotracheal intubation and subsequent tracheotomy. The modified procedure is as follows. In order to enlarge the laryngeal or tracheal lumen, skin is cut and one or two triangle-shaped skin flaps are dissected; their tops are sutured to the anterior wall of the above organs cut along the median line. In order to distend the larynx, redressment of the cricoid cartilage is needed. He-Ne laser irradiation (of 20 mW/cm2 with a wavelength of 632.8 nm) and collagenase and elastase enzymes stimulate repair and prevent secondary cicatrization of post-operative wound. The lumen is formed using a T-shaped silicon tube. Out of 4 patients followed-up during the last 5 years, 21 were decannulated, 12 developed good laryngotracheostoma, 5 of which required suture of wound. Only 8 patients who had laryngotracheostoma needed surgical intervention due to repeated cicatrization. In 4 of these patients, allogenic cartilage was used for support, and polymer paste Polytel was applied to eliminate laryngeal, tracheal or esophageal fistulas.