RECONSTRUCTION OF EXTENSIVE LARYNGOTRACHEAL DEFECTS USING SEPTAL CARTILAGE

Abstract

Introduction. This article examines the potential use of nasal septal cartilage in the management of combined extensive defects of the larynx and upper trachea. Particular attention is given to the significant advantages of septal cartilage compared with other reconstructive techniques. From a physiological standpoint, it is more optimal than other graft materials due to its greater resistance to infection in the surgical wound, lack of immunogenicity, and absence of pronounced biological incompatibility reactions. Cartilage is nourished by diffusion, which makes it more resistant to adverse conditions compared to other tissues. The technique and advantages of the proposed modification of laryngotracheoplasty using septal cartilage for extensive defects are described.
Objective. To develop and evaluate a method of reconstruction for extensive combined defects of the larynx and trachea.
Material and methods. A total of 82 patients with chronic laryngeal and tracheal stenosis of various etiologies, aged 15 to 57 years, were examined at the ENT Clinic of the S.A. Niyazov Medical and Consultative Center (Ashgabat, Turkmenistan). Of these, 47 (57.3%) were male and 35 (42.7%) were female. The age distribution was as follows: under 20 years – 8.5±3.1%; 21-30 years – 48.8±5.5%; 31-40 years – 34.1±5.2%; and 41-57 years – 8.5±3.1%. The highest incidence was observed in the working-age population (21-40 years), comprising 68 patients (82.9%).
Clinical diagnosis was established using objective methods, including direct and indirect laryngoscopy, lateral radiography of the larynx and trachea, fiberoptic bronchoscopy, computed tomography, and magnetic resonance imaging.
Results and Discussion. Comparative analysis of the proposed laryngotracheoplasty technique using septal cartilage versus reconstructive methods without grafts demonstrated a statistically significant improvement in treatment outcomes (p<0.05). During follow-up of up to one year, no cases of biological incompatibility, graft rejection, resorption, or adverse local tissue reactions were observed. One exception involved a patient who developed subcutaneous wound discharge, which resolved after local anti-inflammatory therapy without the need for additional surgical intervention.
Conclusion. It was established that in cases of combined extensive defects of the larynx and upper trachea measuring more than 1.5 cm, with preservation of at least two-thirds of the lateral walls of the cricoid cartilage, stable airway support can be achieved. This is possible when the anterior wall is reconstructed as a two- or three-layer structure (using internal and external layers), and septal cartilage is fixed to the cartilage in the first layer at the center of the defect, providing sufficient rigidity even with relatively small graft size.