PROGNOSIS.—The prognosis is always unfavorable in malignant cases, and also in non-malignant when the tumor grows rapidly or has already attained a large size. The introduction of the laryngoscope has bettered the prognosis, inasmuch as in many cases early recognition enables us, by performing tracheotomy, to prevent sudden death from suffocation, and also because by the aid of the mirror removal has been accomplished through the natural passages.
TREATMENT.—Removal of a tracheal tumor through the natural passages by means of either cutting or cautery instruments requires so much special ability on the part of the operator that it need not be described in detail in a work designed for general medical practitioners. When the tumor is situated above a point at which tracheotomy can be judiciously performed, no physician worthy of the name should hesitate to lay open the trachea in any case in which suffocation is impending. Removal of the tumor by surgical operation after opening the windpipe may be attempted or not according to circumstances, but in all cases palliative measures by sedative inhalation and otherwise may be resorted to, and the patient's general health, especially in malignant cases, must be kept up as much and as long as possible.
STENOSIS.
DEFINITION AND PROXIMATE ETIOLOGY.—Stenosis is narrowing or more or less occlusion of the windpipe. It is either stricture or constriction from within, or compression from without, or both combined. Constriction within the trachea is due to swelling or thickening or cicatricial displacement of the mucous membrane or other tissue, inversion of its walls, or morbid growth or foreign body in its interior. Compression from without is due to goitre (which has in some cases prevented viability) or other disease of the thyroid body; aneurism; abscess; enlarged bronchial glands or cervical lymphatics; disease of the sternum, clavicle, or vertebræ; mediastinal tumor; cystic, emphysematous, or other tumor of neighboring tissue; or foreign body. According to Rose's observations of goitre,3 compression of the trachea leads to fatty degeneration of the cartilages and their subsequent softening and absorption; after which, the windpipe having become membranous throughout and no longer patulous, death can easily—in some positions or flexion of the body, etc.—take place.
3 Der Kropftod und die Radicalcur der Kröpfe, Berlin, 1878.
In acute tracheitis, though there is swelling of the mucous membrane, the large size of the tube usually obviates stenotic symptoms, while chronic tracheitis does occasionally lead to sufficient contraction to interfere with respiration; but generally stenosis is the result of syphilis, and frequently follows ulceration and cicatrization. In a case recorded in the Bullétin des Sciences médicales for January, 1829, the lumen of the trachea was reduced to two lines.
| FIG. 32. |
| Involution of Trachea, due to aneurism. |
SYMPTOMS AND DIAGNOSIS.—The main symptom is the peculiar, gradually increasing dyspnoea; once observed, it is recognized without much difficulty. There may also be mucous râles; cough rough and sibilant; attempts at clearing the throat without expectoration, or occasionally with some expectoration, which is at first light-colored, then streaked with blood, and at last purulent, but never abundant (unless accidentally complicated by catarrh), and always difficult to eject; perhaps occasional pain, but constant disagreeable sensation (tightness) in the trachea just above the sternum. Tracheoscopy settles the diagnosis. The tracheal rings are seen either as diminished circles or arcs—sometimes concentrically placed, sometimes in two different directions, as shown in a case of tracheal stenosis from compression causing protrusion of the mucous membrane into the interior, represented in Fig. 32, or else constricting bands are visible.