Differential Diagnosis Of Laryngeal Growths In The Larynx Of Adults


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,

namely,

1. Lues.

2. Tuberculosis, including lupus.

3. Scleroma.

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,

tuberculosis.

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.





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