Vocal Results


Categories: INTRODUCTION OF THE BRONCHOSCOPE
Sources: A Manual Of Peroral Endoscopy And Laryngeal Surgery

A whispering voice can always be had as long as air

can pass through the larynx, and this may be developed to a very loud

penetrating stage whisper. If the arytenoid motility has been

uninjured the repeated pulls on the scar tissue may draw out

adventitious bands and develop a loud, useful, though perhaps rough

and inflexible voice.



Galvano-cauterization is the best method of treatment for chronic

subglottic edema or hyperplasia such as is seen in children following

diphtheria, when the stenosis produced prevents extubation or

decannulation. The utmost caution should be used to avoid deep

cauterizations; they are almost certain to set up perichondritis which

will increase the stenosis. Some of the most difficult cases that have

come to the author have been previously cauterized too deeply.



Galvano-cautery puncture of tuberculous infiltrations of the larynx

at times yields excellent results in cases with mild pulmonary

lesions, and has quite replaced the use of the curette, lactic acid,

and other caustics. The direct method of exposing the larynx renders

the application of the cautery point easy and accurate. In severely

stenosed tuberculous larynges a tracheotomy should first be done, for

though the reaction is slight it might be sufficient to close a

narrowed glottis. The technic is the usual one for laryngeal

operations. Local anesthesia suffices. The larynx is exposed. The

rheostat having been previously adjusted to heat the electrode to

nearly white heat, the circuit is broken and the electrode introduced

cold. When the point is in contact with the desired location the

current is turned on and the point thrust in as deeply as desired.

Usually it should penetrate until a firm resistance is felt; but care

must be used not to damage the cricoarytenoid joint. The circuit is

broken at the instant of withdrawal. Punctures should be made as

nearly as possible perpendicular to the surface, so as to minimize the

destruction of epithelium and thus lessen the reaction. A minute gray

fibrous slough detaches itself in a few days. Cautery puncture should

be repeated every two or three weeks, selecting a new location each

time, until the desired result is obtained. Great caution, as

mentioned above, must be used to avoid setting up perichondritis. Many

cases of laryngeal tuberculosis will recover as quickly by silence and

a general antituberculous regime.



Radium, in form of capsules or of needles inserted in the tissues

may be applied with great accuracy; but the author is strongly

impressed with pyriform sinus applications by the Freer method.



After-care of endolaryngeal operations includes careful cleansing of

the teeth and mouth; and if the extrinsic area of the larynx is

involved in the wound, sterile liquid food and water should be given

for four days. The patient should be watched for complications by a

special nurse who is familiar with the signs of laryngeal dyspnea

(q.v.). Complications during endolaryngeal operations are rare.

Dyspnea may require tracheotomy. Idiosyncrasy to cocain, or the sight

or taste of blood may nauseate the patient and cause syncope. Serious

hemorrhage could occur only in a hemophile. The careless handling of a

bite block might damage a frail tool or dental fixture.



Complications after endolaryngeal operations are unusual.

Carelessness in asepsis has been known to cause cervical cellulitis.

Emphysema of the neck has occurred. Edema of the larynx occasionally

occurs, and might necessitate tracheotomy. Serious bleeding after

operation is very rare except in bleeders. Hemorrhage within the

larynx can be stopped by the introduction of a roll of gauze from

above, tracheotomy having been previously performed. Morphin

subcutaneously administered, has a constricting action on the vessels

which renders it of value in controlling hemorrhage.





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