Inspection Of The Party Wall In Cases Of Suspected Laryngeal Malignancy
Categories: BRONCHOSCOPY IN MALIGNANT GROWTHS OF THE TRACHEASources: A Manual Of Peroral Endoscopy And Laryngeal Surgery
When taking a specimen the party wall should be
inspected by passing a laryngoscope or, if necessary, an esophageal
speculum down through the laryngopharynx and beyond the
cricopharyngeus. If this region shows infiltration, all hope of cure
by operation, however radical, should be abandoned.
Radium and the therapeutic roentgenray have given good results, but
not such as would warrant their exclusive use i
malignancy in the larynx operable by laryngofissure. With inoperable
cases, excellent palliative results are obtained. In some cases an
almost complete disappearance of the growth has occurred, but
ultimately there has been recurrence. The method of application of the
radium, dosage, and its screening, are best determined by the
radiologist in consultation with the laryngologist. Radium may be
applied externally to the neck, or suspended in the larynx;
radium-containing needles may be buried in the growth, or the
emanations, imprisoned in glass pearls or capillary tubes, may be
inserted deeply into the growth by means of a small trocar and
cannula. For all of these procedures direct laryngoscopy affords a
ready means of accurate application. Tracheotomy is necessary however,
because of the reactionary swelling, which may be so great as to close
completely the narrowed glottic chink. Where this is the case, the
endolaryngeal application of the radium may be made by inserting the
container through the tracheotomic wound, and anchoring it to the
cannula.
The author is much impressed with Freer's method of radiation from the
pyriform sinus in such cases as those in which external radiation
alone is deemed insufficient.
The work of Drs. D. Bryson Delavan and Douglass M. Quick forms one of
the most important contributions to the subject of the treatment of
radium by cancer. (See Proceedings of the American Laryngological
Association, 1922; also Proceedings of the Tenth International
Otological Congress, Paris, 1922.)
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