(Killian’s Method)
Fig. 256. Multiple Papillomata of the Larynx. (From Specimen No. 1647 in the Museum of St. Bartholomew’s Hospital.)
Indications. (i) Multiple papillomata. These tumours occur most commonly during the early years of life, and operations for their removal present great difficulties, first, in their removal, and, secondly, owing to their inveterate tendency to recurrence whatever operation is performed; moreover, in some instances operation seems to stimulate the growths to greater activity. The case reported by Stoker is a well-known instance. He was consulted by a man thirty years of age who had suffered from papilloma for twenty-three years, during which period one surgeon had performed 100, and a second 120 operations.
(ii) Benign tumours other than papillomata, which are not amenable to operation by indirect laryngoscopy.
(iii) Foreign bodies. Direct laryngoscopy is advised for patients who are intolerant (e.g. young children), or when the object is firmly impacted, or when other methods of treatment have failed. Thus in one of my cases a man presented himself with a long pin impacted transversely above the vocal cords; it was found impossible to remove it by indirect laryngoscopy without serious injury to the parts. An anæsthetic was therefore given and a large tube-spatula passed into the larynx: with strong forceps the pin was bent upwards and removed with ease.
(iv) Granulations, ulcers, necrosis, and other inflammatory conditions such as are caused by diphtheria, tubercle, syphilis, and many other diseases.
(v) For diagnostic purposes. There can be little doubt that direct laryngoscopy has a great future before it as a means of determining the nature of doubtful laryngeal conditions. If the upper parts of the larynx be swollen, if there be any stenosis such as follows ulceration, or if the patient be intolerant, the air-passages cannot be thoroughly examined with the laryngoscope alone. With the newer method many of these difficulties have disappeared, and it is now possible for the surgeon to diagnose with certainty many conditions which would otherwise have remained doubtful.
The apparatus required consists of: