Edema of one side of the body
Laryngeal edema is not an independent disease, but only one of the manifestations of many pathological processes.
Edema of the larynx is most common in men aged 18 to 35 years, but can be observed in childhood and old age.
Etiology and pathogenesis of the laryngeal edema. Swelling of the larynx can be inflammatory and non-inflammatory in nature. One of the frequent causes of the first are mechanical injuries of the larynx, for example, foreign bodies during surgical interventions (galvanic caustic), in children with prolonged bronchoscopy or burns of the larynx with hot food and solutions of caustic acids and alkalis.
Sometimes swelling occurs after X-rays orradiotherapy of the neck. When the suppuration in the throat, okologlochechnom space, cervical spine, the root of the tongue, the lower pole of the palatine tonsil, soft tissues of the bottom of the mouth can also develop inflammatory laryngeal edema.
Sometimes it develops with some acute (measles,scarlet fever, flu, typhus) and chronic (tuberculosis, syphilis) infectious diseases. Laryngeal edema can be associated with both lesion of the mucous membrane only and inflammation in the perichondrium and in the cartilage of the larynx.
Non-inflammatory edema of the larynx is observed whendiseases of the cardiovascular system, kidneys, cirrhosis of the liver, general cachexia, with local disturbance of blood circulation as a result of compression of veins and lymphatic vessels of the neck. Sometimes swelling of the larynx occurs when idiosyncrasy to some foods (strawberries, cottage cheese, crawfish, etc.) or medicinal substances.
In the latter case, they arise most often inthe first days of taking iodine preparations, and the amount of medication taken does not determine the time and degree of development of the laryngeal edema. To the same group of edema is the angioedema of the larynx, which is often combined with edema of the face and neck.
Edema usually develops in those parts of the larynx,where a loose connective tissue is richly represented in the submucosal layer, i.e. on the lingual surface of the epiglottis, in the scoop-epiglottin folds, on the posterior wall of the larynx and in the subglottic space; much less often, swelling is limited to false and true vocal cords or the area of the petiolus.
In the areas of edema submucosal tissue sharplythickened, connective tissue fibers dilated serous exudate with scanty content or complete absence of cellular elements. If the inflammatory process takes place with the participation of a virulent infection, then inflammatory infiltration of the submucosal layer is attached to these phenomena. Congestive swelling usually spreads to significant areas of the larynx and are located symmetrically on both sides, and inflammation often occupy a limited area of the larynx and are asymmetric.
Symptomatology and diagnosis of laryngeal edema.
With inflammatory edema of the epiglottis, patients complain of pain when swallowing, a feeling of pressure, a foreign body, sometimes a pincher.
In the case of a slight swelling in the arytenoid cartilage there is a sensation of tension or constriction of the larynx, and when spreading it to the pear-shaped fossa, sometimes painful pain occurs when swallowing.
With significant edema scoop-epiglottisfolds, with its development in the true vocal cords and in the subglottic space, the symptoms of laryngeal stenosis, which increase during sleep and when the patient is horizontal, can develop.
Violations of the voice are caused by a violation of the mobility of the arytenoid cartilages and the involvement of the true vocal cords in the inflammatory process. If there are no such changes, then the voice can remain pure.
Slightly developed and slowly developingnon-inflammatory edema can pass unnoticed for the patient; significant edema of the epiglottis and scoop-epiglottis folds are accompanied by awkwardness and difficulty in swallowing. A sharp and rapidly developing edema, especially when involving true and false vocal cords and subglottic space, is accompanied by stenotic phenomena. With the slow development of edema, despite a significant narrowing of the lumen of the respiratory tube, a pronounced difficulty in breathing may not be present.
Recognition of the inflammatory laryngeal edemais based on the account of complaints, laryngoscopic picture and general condition of the patient. Detection in different parts of the larynx edematous pale pink, glassy translucent mucous membrane indicates the edema of the larynx. It is more difficult to establish the cause of the edema and to predict the further development of the process - whether it will be limited to the stage of edema followed by regression, or in the future, phlegmonous inflammation will join it.
It is very important to find out the status of adjacent organs, the defeat of which is often the cause of the laryngeal edema.
With non-inflammatory laryngeal edema, the mucosathe shell has the form of translucent, gelatinous grayish or yellowish blooms with a shiny surface, soft when probing. When establishing a diagnosis, the history and general examination of the patient should be taken into account.
Edema of the epiglottis spreads by itslingual surface without going over to the laryngeal surface, since there is almost no loose connective tissue in the submucosa of this region. Lingually-epiglottis fossae flatten or become less pronounced. The epiglottis loses its shape and deviates to one side or the other. From the lateral parts of the epiglottis, the edema sometimes extends to the scapular-epiglottis folds and to the walls of pear-shaped pits.
The edema of the region of the petiolus most often extends here from the scapular-epiglottis folds and reaches only small dimensions.
With moderate edema scoop-epiglottisfolds it thickens, its free edge is rounded, making indistinguishable elevations of Vrysberg and Santorini cartilage. With sharply expressed edema scoop-epiglottis folds significantly increase in volume; with each inhalation, their free edges move toward the laryngeal lumen, sometimes causing suffocation. Quite often, swelling of scoop-epiglottis folds is accompanied by swelling of the mucous membrane of the arytenoid cartilages.
Serous effusion with edema of true vocalligaments spreads in the subepithelial layer, and sometimes in the intermuscular connective tissue layers. With two-sidedness of such changes, the lumen of the glottis can sharply narrow.
With edema in the subglottic space, there is a cushion-like protrusion under the true vocal cords.
The flow of the process is different and can not always be accurately predicted.
Therefore, it should be remembered that with the swelling of the larynx, the state of relative well-being can suddenly be replaced by severe stenosis.
At the beginning of the development of inflammatory edemarecommend swallowing ice slices. At the same time, warming compresses, poultices on the neck or leeches can be prescribed. Sometimes it is advisable to make incisions on the swollen mucosa of the larynx. An autopsy of the causative foci of suppuration in the larynx or in adjacent organs can quickly eliminate the laryngeal edema. In case of threatening symptoms of suffocation, an autopsy should be preceded by a tracheotomy. The inhalation of oxygen sometimes has a beneficial effect on edema of the larynx.
With angioneuroticheskih edema injected subcutaneouslyatropine, intravenously 5-10 ml of a 10% solution of calcium chloride, produce a cervical novocain blockade. With the beginning of edema of the larynx, a good result is a treatment with diphenhydramine (0.025 g from 2 to 4 times a day) (BS Preobrazhensky, NA Pautov).
Recently, both with inflammatory andfor allergic edema of the larynx, adrenocorticotropic hormone (ACTH), cortisone, dehydrocortisone (5-10 units of ED intramuscularly 4 times a day or as tablets orally, 0.05 4 times a day) is used until the acute effects abate [Liden-uk, Flynn ( T. Flynn), Semter (M. Samter)]. Favorable action has intravenous administration of glucose, urotropin, intranasal novocaine blockade (LB Dainiak and others). As a distraction, you can assign hot foot baths, mustard plasters to the calves. With cardiac edema, cardiac remedies are prescribed, with edema caused by kidney disease, restriction of drinking, table salt, diuretics, and sometimes bloodletting.
Patients with hypostases of the larynx should be necessarily hospitalized.
Prediction is always serious and depends on the nature of the course of the process, complications and causes that caused laryngeal edema.