Pathological anatomy of the laryngeal scleroma.
The scleroma of the larynx begins with the formation of dense submucosal infiltrates, consisting of small rounded cells and plasmocytes, as well as a large number of spindle-shaped cells and fibroblasts that complete the formation of the scleral focus, turning it into a dense tumor. The cylindrical epithelial cells located above the infiltrate are transformed into a multilayer flat keratinizing epithelium. Sclerous infiltrates do not undergo decay, and the mucous membrane - ulceration. Scleral foci evolve over a number of years, then cicatrize, which leads to stenosis of the larynx and disruption of its respiratory and voice-forming functions.
Symptoms and clinical course of the laryngeal scleroma.
The disease begins gradually, showing signs of banal catarrhal laryngitis, which then goes to the "dry phase". Simultaneously, similar phenomena are observed in the superior airway. Since scleral infiltrates are localized mainly in the backbone space, the earliest sign is a violation of breathing, and then, as the infiltration spreads to the voice apparatus, dysphonia and aphonia are added.
Laryngoscopy reveals pale pink infiltrates, which are usually located symmetrically under the vocal folds, spreading over time to the entire circumference of the larynx. Possessing the property of creeping spread, infiltrates can reach the trachea and the main bronchi. Where the process of scarring begins, they acquire a whitish shade and become denser.
The laryngeal lumen is considerably narrowed by annular stenosis, breathing becomes noisy, hissing, and with shortness of breath, dyspnea occurs. The epithelium covering the infiltrates is covered with a tightly adhering whitish-muddy secret, which gives off a sweetish-sugary smell (not fetid, as in the lake, but quite unpleasant).
Diagnosis of laryngeal scleroma.
The diagnosis with advanced forms of the disease does not cause difficulties, especially in cases when similar lesions are detected at the same time in the nasal cavity and pharynx. Gives scleroma and a characteristic sweetish-sugary smell felt at a distance. If scleral lesions affect only the larynx, they should be differentiated with other specific diseases and tumors. Along with various methods of examining the patient (lung radiography, serological tests, bacteriological research) for a final diagnosis, a biopsy is necessary. The material is sampled with direct laryngoscopy or even in some cases with dissection of the thyroid cartilage from the depth of the infiltrate, because of its density with indirect laryngoscopy, the instrument usually slides over the surface of the mucosa and does not penetrate into the depth of the infiltrate.
The prognosis for life is favorable, and in relation to the functions of the larynx depends on the degree of severity of the process. Often, such patients need multiple plastic surgeries and even become lifelong cannulae.
Treatment of laryngeal scleroma.
Treatment with conservative methods practically does not differ from that in rhinoscleroma. The peculiarity of treatment for sclerosis of the larynx is its focus on the elimination of stenosis and the provision of respiratory and voice functions. For this purpose, methods of endolaryngeal surgery using a surgical laser, methods of dilatation of the narrowed parts of the larynx are used. The effectiveness of these methods is not high enough due to relentless relapses. In severe stenoses, tracheostomy is applied, after which the scar tissue is removed through access to the laryngophyssura followed by laryngeal plasty by skin-fascial flaps.