Peroral endoscopy and laryngeal surgery . ondrial necrosis with consequent laryngeal sten-osis. The thyroid cartilage is split up the median line with the turbino-tome (Fig. HIS ). In making this d\\> with the turbinotome, it is essentialin cases of growtlis that are close to the anterior commissure, to make thecut sufficiently to one side to avoid cutting tlirough the growth, in com-pliance with the well known surgical principle that it is necessary to avoidcutting through malignant tissue. Ior this purjiose it is always necessary 66-i TECHNIC OF TIIYROTOMV FOR MALICNAXT DISEASK OF THE LAR
Peroral endoscopy and laryngeal surgery . ondrial necrosis with consequent laryngeal sten-osis. The thyroid cartilage is split up the median line with the turbino-tome (Fig. HIS ). In making this d\\> with the turbinotome, it is essentialin cases of growtlis that are close to the anterior commissure, to make thecut sufficiently to one side to avoid cutting tlirough the growth, in com-pliance with the well known surgical principle that it is necessary to avoidcutting through malignant tissue. Ior this purjiose it is always necessary 66-i TECHNIC OF TIIYROTOMV FOR MALICNAXT DISEASK OF THE LARYNX. to have previously made an accurate localization by laryngoscopy, director indirect. In some instances, it may be found necessary to split thecricoid cartilage, though, as a rule, this should be avoided. In reopera-tions the old incision must be followed (See Fig. 4l)!M. The lateral wingsof the thyroid cartilage are easily spread with retractors, giving a goodview of the interior of the larx. The cricoid cartilage, because it is a. Fin. 488.—Illustration of thjrotomy or laryngofissure. A, shows the line olincision through the thyroid cartilage. The tubinotome is inserted at the crico-thyroid membrane, the points passing upward (Fig. 468). B, shows retractorsplaced inside the larynx to hold back the wings of the divided thyroid the median line is seen the insufflation anesthesia catheter. The growth is onthe left vocal cord. Perichondria! dissection begins at the divided edge of thethyroid cartilage, the retractor being shifted to the bared cartilage as soon as suf-ficient perichondrium has been separated. It will be noted that the cords do notlook like the thin bands seen perorally. They are identified by their position be-low the ventricle. complete ring, spreads less easily if partially ossified, as it often is Caremust be taken not unnecessarily to injure the divided ends of any of thecartilages, in using retractors or otherwise. The most astonishing thin
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectrespira, bookyear1915
