Benign Growths In The Larynx

Benign growths in the larynx are easily and accurately removable by

direct laryngoscopy; but perhaps no method has been more often misused

and followed by most unfortunate results. It should always be

remembered that benign growths are benign, and that hence they do not

justify the radical work demanded in dealing with malignancy. The

larynx should be worked upon with the same delicacy and respect for

the normal tissues that are customary in dealing with the eye.

Granulomata in the larynx, while not true neoplasms, require

extirpation in some instances.

Vocal nodules, when other methods of cure such as vocal rest,

various vocal exercises, etcetera have failed may require surgical

excision. This may be done with the laryngeal tissue forceps or with

the author's vocal nodule forceps. Sessile vocal nodules may be cured

by touching them with a fine galvanocautery point, but all work on the

vocal cords must be done with extreme caution and nicety. It is

exceedingly easy to ruin a fine voice.

Fibromata, often of inflammatory genesis, are best removed with the

laryngeal grasping forceps, though the small laryngeal punch or tissue

forceps may be used. If very large, they may be amputated with the

snare, the base being treated with galvanocautery though this is

seldom advisable. Strong traction should be avoided as likely to do

irreparable injury to the laryngeal motility.

Cystomata may get well after simple excision or galvanopuncture of a

part of the wall of the sac, but complete extirpation of the sac is

often required for cure. The same is true of adenomata.

[202] Angiomata, if extensive and deeply seated, may require deep

excision, but usually cure results from superficial removal. Usually

no cauterization of the vessels at the base is necessary, either to

arrest hemorrhage or to lessen the tendency to recurrence. A diffuse

telangiectasis, should it require treatment, may be gently touched

with a needle-pointed galvanocaustic electrode at a number of

sittings. The galvanonocautery is a dangerous method to use in the

larynx. Radium offers the best results in this latter form of angioma,

applied either internally or to the neck.

Lymphoma, enchondroma and osteoma, if not too extensively involving

the laryngeal walls, may be excised with basket punch forceps, but

lymphoma is probably better treated by radium.* True myxomata and

lipomata are very rare. Amyloid tumors are occasionally met with,

and are very resistant to treatment. Aberrant thyroid tumors do not

require very radical excision of normal base, but should be removed as

completely as possible.

In a general way, it may be stated that with benign growths in the

larynx the best functional results are obtained by superficial rather

than radical, deep extirpation, remembering that it is easier to

remove tissue than to replace it, and that cicatrices impair or ruin

the voice and may cause stenosis.

* In a case reported by Delavan a complete cure with perfect

restoration of voice resulted from radium after I had failed to cure

by operative methods. (Proceedings American Laryngological

Association, 1921.)

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