Peroral endoscopy and laryngeal surgery . the result appears, the small openingshould be allowed to remain patulous for a few months longer to facilitatethe watch for recurrence. In rare cases a number of years have beenrequired for complete cure. Xo case should be called cured until sixmonths have elapsed. Aittof<lasty. The laryngostomy ojiening will rarely unite withoutautoplasty because of its epidermatization. When autoplasty is required,the Berger or Gluck operations, clearly shown in Figs. 479 and 480,will usually close the opening perfectly, though a number of minor sec-
Peroral endoscopy and laryngeal surgery . the result appears, the small openingshould be allowed to remain patulous for a few months longer to facilitatethe watch for recurrence. In rare cases a number of years have beenrequired for complete cure. Xo case should be called cured until sixmonths have elapsed. Aittof<lasty. The laryngostomy ojiening will rarely unite withoutautoplasty because of its epidermatization. When autoplasty is required,the Berger or Gluck operations, clearly shown in Figs. 479 and 480,will usually close the opening perfectly, though a number of minor sec- 643 ondary operations are at times iiecessar)- to close little tistnlae which oc-cur, usually at the corners of the flaps. Like all plastic operations, suc-cess depends uj^on large well nourished flaps, placed without too muchtension. It is necessary, in males, to modify the shape of the flaps toavoid if possihle the turning in of skin bearing coarse hair. The outersurface of the skin Hap is always turned in toward the trachea. In one. Fk;. 481.—IVoni a ]ilirUigr,-L(il) oi a i>atioiit taken two \L-ars aflcT cniiipUtecure of obstinate cicatricial post-typhoid laryriRotraclical stenosis, by laryngostomy.(Four years have elapsed since complete cure and plastic closure. Voice andbreathing arc excellent. Ialicnt was originally tracheotomizcd, in Dr. Joseph II. Barach). of our cases, three plastic operations failed to close a fistula. The entirefront of the neck was a mass of scar-tissue. After each operation, a smallfistula would jiersist. We discovered that it was the ])ressure duringcough that forced a small (ijiening and forced the secretion out, thuscausing a leak. I!y doing a tracheotomy very low in the neck, the pres-sure on the olastic above at the site of the laryngostomy during coughingwas completeh i)revenled. .After healing of the laryngostomy opening 644 LARYXGOSTOMY. was complete, the cannula below was removed and the lower woundpacked in the usual w
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectrespira, bookyear1915
