Kenneth C. Johnston

XLIV Benign Tumors of the Larynx

The extremely thorough and valuable work of New and Erich on Benign Tumors of the Larynx serves as a reference in regard to these tumors. This discussion of our own series of benign laryngeal tumors is prepared in a similar manner for statistical purposes. It consists of an analysis of 1197 patients with benign laryngeal growths that have been examined at St. Lukes and The Childrens Memorial Hospitals and at the Research and Educational Hospitals of the University of Illinois, Chicago, during the past 15 years.

LXVIII Tracheal and Bronchial Obstruction Due to Congenital Cardiovascular Anomalies

Recent achievements in thoracic surgery and advances in diagnostic techniques have aroused new interest in congenital cardiovascular anomalies. Certain of the major anomalies are now being routinely and successfully treated by surgery, and the utilization of surgical methods in this field is rapidly being broadened, If full advantage of these newer procedures is to be realized, it is imperative to recognize these developmental defects promptly and to differentiate the specific types amenable to surgery.

Laryngeal trauma and its complications

Abstract 1. 1. A review of eighty-two patients who sustained external trauma to the larynx shows the commonest cause to be automobile and other vehicular accidents (forty-three cases). Other vehicular accidents involved streetcars, buses, trains, airplanes, a tractor, bicycle and sled. In the automobile accidents the laryngeal injury was usually one of multiple injuries and it occurred as frequently in females as in males. 2. 2. Next in frequency as a cause of laryngeal trauma is physical violence (twenty-nine cases), i.e. garroting, “strong arm,” blow by edge of hand, gunshot, cutthroat, boxing and being struck by a baseball or golf ball. Twenty-seven of this group were males, only two females. 3. 3. Ten patients, all men, received their laryngeal injuries in industrial accidents, being struck in the neck by a “two by four,” striking projecting machinery or falling while carrying a heavy object and striking an edge of it in the fall. Three men had put their heads through open windows or horizontal elevator doors, the doors or windows closing on the neck. 4. 4. Minimal injuries cause hoarseness, dysphonia and aphonia. The pathologic conditions included hematomas, lacerations of the cords or other soft tissues, and dislocations or fractures of laryngeal cartilages. Respiratory obstruction is evidence of more severe injury and may vary in degree from slight respiratory embarrassment to total atresia and asphyxia. 5. 5. Diagnosis is established by palpation, mirror and direct laryngoscopic examinations of the larynx and x-ray films of the neck, particularly the lateral view. 6. 6. Treatment of minimal injuries consists of hot packs, voice rest (silence) and steam inhalations, with voice rehabilitation to help restore this important laryngeal function after the acute manifestations have subsided. 7. 7. Severe injuries to the larynx require low tracheotomy to establish the airway. Then, as soon as the patients general condition will permit, broken cartilages must be replaced and held in position by an intralaryngeal splint or mold to insure an adequate airway. If manipulation perorally cannot be accomplished because of an associated fractured jaw, this must be performed through the tracheostomy or by external, open reduction. 8. 8. Failure or inadequate early management results in chronic laryngeal stenosis and the need of a permanent tracheostomy. Treatment of this complication requires reconstruction of the laryngeal lumen through the removal of scar and deformed cartilage and the lining of the interior of the larynx with a split thickness skin graft. This long and tedious process can be avoided by early reduction and fixation of the laryngeal fractures.

LXXVIII Postsurgical Endoscopic Problems of Congenital Esophageal Atresia

There are a number of recurring problems following surgery for congenital esophageal atresia and tracheoesophageal fistula that require endoscopic management. Some are strictly laryngeal, some tracheobronchial or esophageal, and others are combined bronchoesophageal problems associated with the anomaly or with the corrective surgical procedures. Analysis may aid in the prevention, diagnosis or treatment of some of the complications.

Esophageal diseases in infants and children.

Esophageal dysfunction in an infant or child usually results from congenital or traumatic lesions or chemical burns. Congenital conditions include benign strictures and webs, a short esophagus and atresia. The swallowing of foreign bodies and chemicals accounts for most of the traumatic lesions. Cardiospasm and esophageal varices are relatively uncommon in children; however, esophagitis occurs frequently. The authors discuss the diagnosis and treatment of each of these conditions.

Pathology of the larynx: a photographic analysis.

The purpose of this paper is to present a photographic record of some of the more common types of laryngeal pathology. The gross appearance of the larynx is shown as it is seen with the laryngeal mirror or through the direct laryngoscope. Beginning the series of photographs are indirect views of the normal larynx, followed by the direct views of the landmarks visualized during the introduction of the laryngoscope. Subsequent photographs are those of individual cases. A photomicrograph of the biopsy specimen and in two cases photographs of the laryngectomy specimen are presented with the laryngoscopic picture to correlate the gross and microscopic pathology. A brief history, the histological diagnosis and the microscopic description are given for each case.