This table shows that nearly half the cases were treated by laryngotomy. In sixty-three of these, where the tongue or floor of the mouth was concerned, no preliminary ligature of the lingual artery was performed; of the seventy-three similar cases treated without laryngotomy there was preliminary ligature of one lingual in thirty-one cases (42.5%), and of both arteries in twelve cases (16.4%).
From this it is apparent that lary[n]gotomy has to some extent taken the place of preliminary ligature of one or both linguals. The operation is simple, rapid in execution, and meets all requirements; it is not surprising to find, therefore, that in recent years the number of laryngotomies has proportionately increased.
Table showing Operations as performed in different Years
| Year. | Cases. | With Laryngotomy. | Without Laryngotomy. |
|---|---|---|---|
| 1902 | 039 | 19 | 20 |
| 1903 | 035 | 05 | 30 |
| 1904 | 031 | 16 | 15 |
| 1905 | 032 | 18 | 14 |
| 1906 | 029 | 18 | 11 |
| 1907 | 021 | 14 | 07 |
| Total | 187 | 90 | 97 |
Operation. In cases of extreme emergency the operation can be performed with almost any kind of knife, but the following instruments are preferred: a sharp-pointed bistoury or tenotome, a sharp-pointed dilator (Fig. 265, B), a tube and introducer. The tube should be small, short, with a fixed collar, and made of silver; an introducer such as Butlin’s is a great advantage (Fig. 265, A). As bleeding may occur, it is necessary to prepare dissecting forceps, retractors, pressure forceps and catgut.
Fig. 265. Instruments for Laryngotomy. A, Tube and introducer (Butlin’s); B, Sharp-pointed dilator (Bailey’s).
A general anæsthetic is usually employed when infrathyreoid laryngotomy forms the first stage of the main operation, but it should be remembered that the amount of chloroform required is less when given through a tube.
The preparation of the skin and the position of the body are the same as for tracheotomy. A transverse incision one inch in length is recommended, and this should lie directly over the crico-thyreoid interval, which is easy to determine in the adult. The incision can be made quickly by pinching up a vertical fold of skin, transfixing immediately above the cricoid, and cutting outwards: with this method the anterior jugular veins are rarely wounded, but if any vessel has been pricked it should be seized and tied at once.