Topbar_layered     this website was appraised in july 2004 by c-h-i-q the centre for health information quality ‘working to maximise public confidence in health information’. buy viagra online australia fast delivery Laryngotracheal reconstruction (ltr) in children indications ltr is an operation for the treatment of established laryngeal and subglottic stenosis. Its principle is to enlarge the cartilaginous skeleton of the larynx and trachea, thus widening the airway. Viagra cost nhs Anaesthetic general anaesthetic. buy viagra on line without prescription Technique an initial microlaryngoscopy and bronchoscopy is usually performed. viagra viagra used together The neck skin is opened through a horizontal incision and the larynx and trachea are exposed. viagra y alcohol consecuencias The airway is then split open vertically in the mid-line opening both its front and back walls if necessary and dividing the narrowed area. generic viagra from the united states A separate skin incision is made on the front of the chest wall and a piece of costal cartilage is removed (costal cartilages join the ribs to the breast bone). viagra for sale cheap The chest incision is sewn up and the piece of cartilage is shaped so that it can be keyed into the wall of the larynx to hold it open. The airway needs to be held open while healing takes place. cost viagra prescription australia Depending upon the nature of the case, this is either done with an endotracheal tube which can be removed 10 days later (single stage operation) or by a plastic former (stent) held in place by a stitch under the skin. In single-stage operations the patient is nursed on the intensive care unit until the tube has been removed. In two-stage operations the child needs to breathe through a tracheostomy until the stent has been removed at a second operation several weeks later and the airway has settled down. buy viagra generic In some cases of subglottic stenosis, where there is a short narrowed segment, the operation of cricotracheal resection is possible. generic viagra without presciption usa The principle of this is to remove the narrowed section of airway and sew the ends together directly. buy generic viagra online The after care is the same as a laryngotracheal reconstruction. Viagra frei kaufen It is likely that the child will need a number of subsequent microlaryngoscopies and bronchoscopies both to assess the airway and to control granulation tissue (exuberant flesh which often forms over healing cartilage. viagra online generic ) postoperative medication includes antibiotics and antacids to prevent acid stomach contents coming up the gullet and interfering with the repair. Length of operation 2 to 3 hours depending upon its complexity. viagra for men and women uk Length of hospitalisation this is variable depending on the precise circumstances of the case; it ranges from 1 to 8 weeks. viagra for men and women uk Outcomes ltr is successful in restoring a satisfactory airway in the majority of cases. Cheap viagra drug For a minority of patients, more than one operation may be needed and an unfortunate few will remain permanently tracheostomy dependent. buy viagra online england Risks & complications the risk of operative damage to vital structures is small and similar to those of tracheostomy. viagra for men and women uk The chief postoperative concern is the maintenance of a safe airway since there is the potential for. cheap viagra