An Operation for Cicatricial Stenosis of the Larynx

LARYXGEAL stenoses are produced by varying astiologic factors and display a great variety in their pathologic picture. This fact has resulted in a great variety of therapeutic procedures both operative and conservative. Individualization was imperative: in each case that method was to be chosen by which restoration could be hoped for. Many methods, however, gave rise to disappointment, and we were, after long-lasting experiments, often compelled to employ another method. Operations followed by dilation procedures though frequently resulting in a success, sometimes failed. I had several patients who had been treated for a long time with great perseverance, but the hoped-for restitution did not occur. The new method of operation devised by me resulted in a radical change. Not only the recently admitted patients, but also the older ones considered incurable, have been restored in five months in such a way, that removal of the cannula and closing of the stoma could be carried out. Early after the first World War in which injuries of the larynx had often resulted in cicatricial stenosis, I endeavoured to obtain the best results by the quickest method. One of these methods consisted in dividing the posterior wall of the cricoid cartilage. I tried to solve the problem, i.e. to obtain proper mobilization through bilateral division, at the junction of the posterior and lateral wall, and subsequent dilation with a metal cylinder. Then I tried to obtain a similar result by a single vertical incision in the midline. Though this method proved advantageous in the subsequent dilatation, the result was unsatisfactory. Nevertheless, I wanted to make use of this small advantage and performed the vertical median division in nearly thirty cases. The vertical bisection of the posterior lamina of the cricoid was also done by Galebsky (1927). He aimed, however, at more than general dilation. After the division of the cricoid cartilage he united the free border of the thyroid cartilage with the sternocleidomastoid muscle, in order to widen the anterior part of the larynx. As I have mentioned above, the vertical division of the cricoid and the subsequent dilation seemed to have some advantages; the results