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Endoscopy In Malignant Disease Of The Larynx

Sources: A Manual Of Peroral Endoscopy And Laryngeal Surgery

The general surgical rule applying to individuals past middle life,

that benign growths exposed to irritation should be removed, probably

applies to the larynx as well as to any other epithelialized

structure. The facility, accuracy and thoroughness afforded by

skilled, direct, laryngeal operation offers a means of lessening the

incidence of cancer. To a much greater extent the facility, accuracy,

and thoroughness cont
ibute to the cure of cancer by establishing the

necessary early diagnosis. Well-planned, careful, external operation

(laryngofissure) followed by painstaking after-care is the only

absolute cure so far known for malignant neoplasms of the larynx; and

it is a cure only in those intrinsic cases in which the growth is

small, and is located in the anterior two-thirds of the intrinsic

area. By limiting operations strictly to this class of case,

eighty-five per cent of cures may be obtained.* In determining the

nature of the growth and its operability the limits of the usefulness

of direct endoscopy are reached. It is very unwise to attempt the

extirpation of intrinsic laryngeal malignancy by the endoscopic

method, for the reason that the full extent of the growth cannot be

appreciated when viewed only from above, and the necessary radical

removal cannot be accurately or completely accomplished.

* The author's results in laryngofissure have recently fallen to 79

per cent of relative cures by thyrochondrotomy.

Malignant disease of the epiglottis, in those rare cases where the

lesion is strictly limited to the tip is, however, an exception. If

amputation of the epiglottis will give a sufficiently wide removal,

this may be done en masse with a heavy snare, and has resulted in

complete cure. Very small growths may be removed sufficiently widely

with the punch forceps (Fig. 33); but piece meal removal of malignancy

is to be avoided.