Technic Of Laryngeal Operations

Sources: 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.