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Technic Of Laryngeal Operations
Category: DIRECT LARYNGOSCOPY 2
Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery
Preparation of the patient and
anesthesia have been mentioned under their respective chapters. The
prime essential of successful laryngeal operations is perfect mastery
of continuous left-handed laryngeal exposure. The right hand must be
equally trained in the manipulation of forceps, and the right eye to
gauge depth. Blood and secretions are best removed by a suction tube
(Fig. 9) inserted through the laryngoscope, or directly into the
pharynx outside the laryngoscope.
For the removal of benign growths the author's papilloma forceps,
Fig. 29, or the laryngeal grasping forceps shown in Fig. 17 will prove
more satisfactory than any form of cutting forceps. These growths
should be removed superficially flush with the normal structure. The
crushing of the base incident to the plucking off of the growth causes
its recession. By this conservative method damage to the cords and
impairment of the voice are avoided. For growths in the anterior
portion of the larynx, and in fact for the removal of most small
benign growths, the anterior commissure laryngoscope is especially
adapted. Its shape allows its introduction into the vestibule of the
larynx, and if desired it may be introduced through the glottic chink
for the treatment of subglottic conditions. It will not infrequently
be observed that a pedunculated subglottic growth which is found with
difficulty will be pulled upward into view by the gauze swab
introduced to remove secretions. The growth is then often held tightly
between the approximated cords for a few seconds--perhaps long enough
to grasp it with forceps.
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