The results of these operations, especially during childhood, are by no means satisfactory. In the statistics carried up to 1896, collected by Rosenberg and von Bruns,[10] laryngotomy was performed 143 times on 109 children; 11 were operated upon twice, 3 children three times, and 1 child seventeen times. 52 of the children were under four years of age; 20 died, principally from suffocation with recurrent papillomata; 43 showed recurrences after repeated operation; 40 were cured (i.e. 36%), and of these 10 showed disturbance of voice.
It must be admitted that operations for the treatment of papillomata do not meet with any great measure of success. It seems probable, however, that the results obtained by endolaryngeal removal are better than those obtained by either tracheotomy or laryngo-fissure. To quote Killian[11]: ‘Formerly, and especially from the standpoint of the surgeon, laryngotomy for laryngeal papillomata was very frequently done in little children in whom removal was impossible by endolaryngeal methods. In my judgment, direct laryngoscopy renders such a surgical procedure unnecessary. We can in all cases, with the aid of a tube-spatula under narcosis, remove papillomata, and the operation can be repeated as often as seems necessary.’ These remarks express the general feeling of the present day, and the most important factor in determining the success of operative treatment is early diagnosis. Such diagnosis divides the cases into two classes: those in which the growths are localized, and those in which they are diffuse. The first class is easy to treat by endolaryngeal methods, and, given careful after-treatment, the prognosis is satisfactory. The second class is serious, and far more difficult to treat; when Killian’s method fails the prognosis is very bad. Finally, it must be borne in mind that, as recurrence may not occur for several months, a guarded prognosis must be given in every case.
The removal of other benign tumours and of foreign bodies, and the treatment of granulations, are conducted upon similar lines, and are attended with excellent results.
CHAPTER II
EXTRA-LARYNGEAL OPERATIONS
THYROTOMY
Indications. This operation is performed for two purposes:
(i) To obtain access to the cavity of the larynx when the diagnosis is uncertain, or as a preliminary to other operations.
(ii) As a method of eradicating certain diseases, of which the following are important:—
1. Malignant tumours, both carcinoma and sarcoma, in which an early diagnosis has been made, and so long as they remain intrinsic.