Taking A Laryngeal Specimen For Diagnosis

Sources: A Manual Of Peroral Endoscopy And Laryngeal Surgery

The diagnosis of

carcinoma, sarcoma, and some other conditions can be made certain only

by microscopic study of tissue removed from the growth. The specimen

should be ample but will necessarily be small. If the suspected growth

be small it should be removed entire, together with some of the basal

tissues. If it is a large growth, and there are objections to its

entire removal, the edge of the growth, including apparently normal as

well as neoplastic tissue, is necessary. If it is a diffuse

infiltrative process, a specimen should be taken from at least two

locations. Tissue for biopsy is to be taken with the punch forceps

shown in Fig. 28 or that in Fig. 33. The forceps may be inserted

through the tube or from the angle of the mouth; the extubal method

(see Fig. 58).

[FIG. 58.--Schema illustrating removal of a tumor from the upper part

of the larynx by the author's extubal method for large tumors. The

large alligator basket punch forceps, F, is inserted from the right

corner of the mouth and the jaws are placed over the tumor, T, under

guidance of the eye looking through the laryngoscope, L. This method

is not used for small tumors. It is excellent for amputation of the

epiglottis with these same punch forceps or with the heavy snare.]

Removal of large benign tumors above the cords may be done with the

snare or with the large laryngeal punch forceps. Both are used in the

extubal method.

Amputation of the epiglottis for palliation of odynophagia or

dysphagia in tuberculous or malignant disease, is of benefit when the

ulceration is confined to this region; though as to tuberculosis the

author feels rather conservatingly inclined. Early malignancy of the

extreme tip can be cured by such means. The function of the epiglottis

seems to be to split the food bolus and direct its portions laterally

into the pyriform sinuses, rather than to take any important part in

the closure of the larynx. Following the removal of the epiglottis

there is rarely complaint of food entering the larynx. The projecting

portion of the epiglottis may be amputated with a heavy snare, or by

means of the large laryngeal punch forceps (Fig. 33).