Categories: ENDOSCOPY IN MALIGNANT DISEASE OF THE LARYNX
Sources: A Manual Of Peroral Endoscopy And Laryngeal Surgery
Determination of the nature of the lesion in these cases
usually consists in the diagnosis by exclusion of the possibilities,
2. Tuberculosis, including lupus.
4. Malignant neoplasm.
In the Bronchoscopic Clinic the following is the routine procedure:
1. A Wassermann test is made. If negative, and there remains a
suspicion of lues, a therapeutic test with mercury protoiodid is
carried out by keeping the patient just under the salivation point for
eight weeks; during which time no potassium iodid is given, lest its
reaction upon the larynx cause an edema necessitating tracheotomy. If
no improvement is noticed lues is excluded. If the Wassermann is
positive, malignancy and the other possibilities are not considered as
excluded until the patient has been completely cured by mercury,
because, for instance, a leutic or tuberculous patient may have
cancer; a tuberculous patient may have lues; or a leutic patient,
2. Pulmonary tuberculosis is excluded by the usual means. If present
the laryngeal lesion may or may not be tuberculous; if the
laryngoscopic appearances are doubtful a specimen is taken. Lupoid
laryngeal tuberculosis so much resembles lues that both the
therapeutic test and biopsy may be required for certainty.
3. In all cases in which the diagnosis is not clear a specimen
is taken. This is readily accomplished by direct laryngoscopy under
local anesthesia, using the regular laryngoscope or the anterior
commissure laryngoscope. The best forceps in case of large growths are
the alligator punch forceps (Fig. 33). Smaller growths require tissue
forceps (Fig. 28). In case of small growths, it is best to remove the
entire growth; but without any attempt at radical extirpation of the
base; because, if the growth prove benign it is unnecessary; if
malignant, it is insufficient.