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Taking A Laryngeal Specimen For Diagnosis
Category: DIRECT LARYNGOSCOPY 2
Source: 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
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).
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