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Full text of "Diseases Of The Nose Throat And Ear"

CANCER OF THE LARYNX

179

INVESTIGATIONS. The two key areas in assessing these tumours are the neck
and the vocal cords. The neck should be carefully palpated because there is a
high incidence of glandular metastasis and the presence of palpable cervical
nodes would necessitate a radical neck dissection. If the tumour has spread to
the vocal cords no possibility exists of doing a partial laryngectomy, so they
must be closely examined for evidence of spread. This is best done at direct
laryngoscopy and biopsy but if the tumour is exophytic and the laryngoscope

Fig. 82. Divisions of the larynx.

Level of
lymphatic-
watershed'

fig. 83. Lymph drainage of larynx.

cannot visualize the whole of the cord, a laryngogram will be of great assistance
in assessing the site and mobility of the vocal cords.

TREATMENT. Before the evolution of partial laryngectomy, patients with
laryngeal cancer could only be offered two alternatives—total laryngectomy
or radiotherapy. For smaller tumours most surgeons rejected the idea of the
rather mutilating total laryngectomy and used primary radiotherapy, reserving
total laryngectomy for recurrences. With this policy, surgery was only about