Peroral endoscopy and laryngeal surgery . hy])()dermatic, injection of this solution along theline of incision, will produce absolute analgesia of the skin and partialanesthesia of scar tissue. The interior of the larynx can be anesthetizedin adults by the local swabbing with a iO per cent, cocaine solution. Thismust be ai)plie(l throu!.h the tracheal fistula before commencing to oper- (;34 LARYNGOSTOMV. ate. It will have no effect afterward. The only really painful part isthe thyrotomic clip (Fig. 4()8) and this is over in an instant. Operatioyi. For clearness the operation may be described i
Peroral endoscopy and laryngeal surgery . hy])()dermatic, injection of this solution along theline of incision, will produce absolute analgesia of the skin and partialanesthesia of scar tissue. The interior of the larynx can be anesthetizedin adults by the local swabbing with a iO per cent, cocaine solution. Thismust be ai)plie(l throu!.h the tracheal fistula before commencing to oper- (;34 LARYNGOSTOMV. ate. It will have no effect afterward. The only really painful part isthe thyrotomic clip (Fig. 4()8) and this is over in an instant. Operatioyi. For clearness the operation may be described in foursteps: 1. Opening of the larynx. 2. Incision of the posterior wall. 3. Suture of the mucosa to the skin. 4. Placing of the dilating tube and the dressing. ]. Laryngotomy. This step is described as dividing the tissueslayer by layer, skin, cellular tissue, fascia, thyroid gland, etc. Such pro-cedure is a great waste of time. The simplest method, re(|uiring Init asecond or two, is to insert the lower blade of the inverted turbinotome. Fig. 468.—Turbinotumc 111 to make the thyrotomic clip. The table isnot shown steeply inclined toward the head as it should be before the turbinotomeis inserted. (Fig. 4(>T ) in the tracheal fistubi, as shown in Fig. and to divideall the tissues, including tlie skin, at one clip. The incision must alwaysextend to the tracheotomic fistula, no matter how low, in order that allthe conditions within to be dealt with may be exposed to view and treat-ment. applies with especial force to the granulatory or hyper-plastic spur ( E, Fig. 4(!0), which is so often a factor in i)reventing de-cannulation. In making this clif) in cases in which the thyroid cartilagehas been divided before, as is often the case in the cases that come tothe author, great care should be taken to follow the line of fibrous thyroid cartilage rarely, if ever, unites with cartilaginous tissue, andthe island of cartilage (E, Fig. 4()9) produced b
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectrespira, bookyear1915
