PERICHONDRITIS (perichondritis; Greek peri around, near + chondros a cartilage + - itis) — an inflammation of a nadkhryashchnitsa.
The item — a disease rare. Results usually from an injury or as a complication of the general inf. diseases (belly, sypny or returnable typhus, scarlet fever, flu, ugly face, etc.). Occasionally P. develops as a complication of radiation therapy of throat cancer. The most frequent localization — costal cartilages, cartilages of a throat — usually cricoid and arytenoid (see. Throat ) and an auricle (see. Outside ear ). Due to the early and effective treatment of the majority of infections postinfectious P. became a big rarity.
P.'s source of a throat, as a rule, are various injuries of a mucous membrane of a throat, to-rye serve as entrance gate for contagiums. P.'s development in a throat is connected with an ulceration of a mucous membrane and a submucosa, napr, at tuberculosis, syphilis, measles, formation of decubituses and damages, napr» at an intubation.
Less often P. develops owing to hematogenous generalization of an infection, at sepsis, natural smallpox. Defeat of a nadkhryashchnitsa (I eat. Cartilaginous tissue) in these cases, as a rule, has secondary character. Contagiums get into a nadkhryashchnitsa with a blood flow, on limf, to cracks or through sites of injury of a mucous membrane.
Morfol, P.'s manifestations find hl. obr. in a nadkhryashchnitsa of a throat and costal cartilages. The item of arytenoid cartilages (clumsy necroses, tuberculosis) can bring in the subsequent to their sequestration. The Dekubitalny ulcers with the subsequent P. arising at a long intubation are localized by hl. obr. in a cricoid. Hematogenous P. arises both on internal, and on an outer surface of cartilages of a throat and edges. The originality morfol, changes at P. is caused by anatomo-histologic features of a structure of a nadkhryashchnitsa and a cartilage, in particular the fact that in a cartilage there are no vessels and therefore at amotio and destruction of a nadkhryashchnitsa the cartilage is exposed to a necrosis (see). Besides, the nadkhryashchnitsa has low proliferative and plastic ability in this connection inflammatory process in it has usually alterativno-exudative character (see. Inflammation ).
The most often found purulent P. develops in the layers of a nadkhryashchnitsa which are directly adjoining on a cartilage — purulent exudate otslaivat a nadkhryashchnitsa, and then there comes the necrosis and sequestration of a cartilage. Created abscess (see) it can be opened in a throat, a gullet or through soft tissues of a neck on the surface of skin. At an injury or quickly arising ulcers of a mucous membrane of a throat the inflammation of a nadkhryashchnitsa begins with surface layers therefore her amotio, the exposure of a cartilage and formation of a purulent cavity occur slowly. Soft tissues around an affected area of a cartilage infiltrirutsya, condensed, the miositis of surrounding muscles with the subsequent their cicatricial and degenerative regeneration develops. At purulent fusion of infiltrate intermuscular is formed phlegmon (see). Are often formed fistulas (see) with rather scanty separated.
The pains of various intensity developing through a nek-swarm time after an injury of a cartilage or inf are characteristic of P. process. Pains gradually accrue and can become iyestershshy. In the affected cartilage the swelling, in the beginning dense, then gradually softened and painful appears at a palpation. In 1 — 2 month fistula with insignificant is formed it is purulent - bloody separated then pains considerably decrease, but completely do not pass.
P.'s current long since healing of the formed defects happens slowly. At P. of costal cartilages inflammatory process can pass to a pleura, a pericardium, a mediastinum. At rather favorable current patol, process in affected areas cicatricial fabric is formed, however its development can lead, e.g., to narrowing and deformation of a gleam of a throat. Sometimes at patients develops sepsis (see), aspiration pneumonia (see) or asphyxia (see). The greatest danger is constituted by P.'s cases of cartilages of a throat: in an acute stage hypostasis of a throat and asphyxia, in the started cases — purulent is possible mediastinitis (see), phlegmon of a neck, etc.
At early stages of P. antiinflammatory and antibacterial therapy can lead to involution of process. At the untimely beginning of conservative treatment or its inefficiency, and also at fistular forms of a nerikhondrit an operative measure — a resection of the affected cartilage within healthy fabrics is shown.
The forecast for life in most cases favorable. In case of asphyxia the lethal outcome is possible.
P.'s prevention consists in rational medical aid at bruises and damages of area of costal cartilages and cartilages of an auricle (processing of microtraumas, primary surgical treatment of wounds, antiinflammatory and antibacterial therapy — according to indications), in the prevention of injuries of a throat at an intubation, rannyom and effective treatment of the infectious diseases able to become the reason of a perichondritis.
Bibliography: Voyno-Yasenetski yv.f. Sketches of purulent surgery, JI., 1956; The Multivolume guide to surgery, under the editorship of B. V. Petrovsky, t. Z, page 273, M., 1964.
E. R. Mathis; G. M. Mogilevsky (stalemate of An.).