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Laryngeal Perichondritis

abscess, larynx, thyroid, cartilage and diagnosis

LARYNGEAL PERICHONDRITIS Idiopathic, as well as secondary perichondritis, is rare in child hood, the former, because it is an unusual condition anyway, and the latter, because its main cause, tuberculosis and syphilis of the larynx, are rare during childhood.

Perichondritis occurs most frequently with ulcerations in the larynx complicating infectious diseases, such as typhoid fever, vari cella, measles, and scarlet fever, septic diphtheria, syphilis, tubercu losis, or as the result of a metastatic deposit..

Symptoms.—The arytenoid and cricoid cartilages, are most fre quently involved, more rarely the epiglottis and thyroid. It is not limited to one cartilage. It is accompanied by high temperature, which may be modified by the fever going with the underlying conffition. A metastatic perichondritis, begins with chills and pain in the larynx. The diseased cartilages cattse pain during the entire course of the dis ease, and are sensitive to pressure.

Difficulty in swallowing is always present, being most marked when the epiglottis, the arytenoid and the thyroid plate are involved. Hoarseness and difficulty in breathing accompany the swelling of the perichondrium. Tbe formation of an abscess may entirely occlude the lumen of the larynx, so that the dyspnera will persist until the abscess opens spontaneously or is incised.

The difficulty in breathing is least with involvement of the thyroid cartilage with external abscess formation. In such cases the subcu taneous abscess can be seen and palpated. The dyspnina is not always entirely relieved when the abscess is opened, because the necrosed cartilage may act as a foreign body in the larynx. :1 laryngeal exam ination, which at the same time clears up the ffiagnosis can often be made. When the abscess is opened and the cartilage thrown out, the

ulceration heals with the fornaation of eicatricial tissue, causing de formity and stenosis of the larynx.

The course of a perichondritis is rapid in septic and acute puru lent processes, and usually slow in cases of syphilis and tuberculosis.

Diagnosis. -The diagnosis is not always easy even when it is possible to make a laryngeal examination, it is difficult in the beginning to make a differential diagnosis between perichondritis and a phleg monous or other severe inflammatory affection.

The history of the case is not always decisive. In ulcerative con ditions, either phlegrnon or perichondritis may result. The course of the disease is quite characteristic. When an external abscess has formed, it must be differentiated from a glandular inflammation m ust of the thyroid gland. The symptom-complex will decide this.

The prognosis depends upon the underlying disease, but is serious in every case, because there may be danger to life. The pronosis is most favorable in syphilitic cases. A chronic hoarseness and stenosis must always be considered.

Treatment.—The underlying disease must first be conquered, the syphilitic cases being the most favorable for treatment. Local treatment consists in the use of leeches or ice compresses, and ice 111 the mouth for the pain in swallowing. The abscess may be opened endo laryngeally, or, when subcutaneous, from without. The sequestrum must also be removed, and filially the resulting stenosis treated, in the accepted way.