THE UVULA AND SOFT PALATE.
ELONGATION OF THE UVULA.
As the result of constant irritation by coughing, or other reflex motions of the pharyngeal muscles produced by local irritation, the uvula frequently becomes elongated to a point which permits it to rest upon the base of the tongue and there to produce still more irritation and reflex phenomena. Patients suffering in this way will be noticed to make frequent attempts at swallowing and coughing, which may be depressing, and may lead to disturbed sleep and even an asthmatic form of breathing. The uvula is a useless organ when it has attained such dimensions, and its amputation, or at least its shortening, are indicated in all such cases as those above described. Local anesthesia is sufficient. Its tip is caught with a pair of forceps and it is clipped off, not too near its base, by long-handled and sharp scissors. This is a much neater and more expeditious method than to include it within the grasp of a wire snare and somewhat slowly crush it off.
Upon the uvula, as upon the soft palate, papular lesions of syphilis are frequently seen, rarely the primary chancre, but very often mucous patches or the deeper ulcers, which characterize the secondary and tertiary lesions. Gummas also may form within the thickness of the palatal tissues, which will in time break down and form ragged ulcers, while the destruction may extend to the bony portions, either of the nose or roof of the mouth, and then necrosis will be added to the evidences of ordinary ulceration. The rapidity with which these specific lesions will disappear under prompt and vigorous constitutional treatment, along with that local cleanliness which should include removal of necrotic tissue, is surprising and gratifying.
THE EPIGLOTTIS.
The epiglottis is composed of yellow elastic cartilage and it does not tend to calcify during the later years of life, as does the white or fibrocartilage of the balance of the larynx. Thus its elasticity and flexibility are fortunately maintained throughout life. It may be sometimes injured by the incised wounds elsewhere described under the term “cut-throat,” and is at least often thus exposed when not actually injured.
The epiglottis seems to be exempt from most of the primary diseases, but is occasionally involved in lesions of surrounding tissues, in which it may then participate. Thus it may be deformed by cicatricial tissue and unduly bound down, or it may succumb to advancing ulceration of syphilis, tuberculosis, or cancer. Injuries which break the laryngeal box rarely affect the epiglottis because of its elasticity.
While an extremely useful portion of the body, the epiglottis is not an absolute necessity, for even after its removal individuals can swallow, although the act requires some extra care. Should the epiglottis become involved in cancerous disease it should be removed with the rest of the diseased tissue, while syphilitic and tuberculous lesions will usually prove amenable to a combination of local and general treatment. New-growths in this region are extremely uncommon, but will prove relatively easy of removal when present.
THE LARYNX.
The laryngeal cartilages, save the epiglottis, are composed of white fibrocartilage which manifests a tendency in the later years of life to undergo calcification. This makes the organ less elastic, changes the tonal qualities of the voice, and makes it more brittle and subject to possible fracture by external violence. Fractures of the organ, as of the adjoining hyoid bone, have been elsewhere discussed, with the indications which may make an emergency tracheotomy necessary because of hemorrhage or edema of the narrow laryngeal passage.