MULTIPLE PAPILLOMATA OF THE LARYNX. 
A Case Presented to the Cincinnati Academy of Medicine, June 25 and October 29, 18 
BY 
MAX THORNER, M.D., 
CINCINNATI, 
PROFESSOR OF CLINICAL LARYNGOLOGY AND OTOLOGY IN THE CINCINNATI COLLEGE OF MEDICINE AND SURGERY; 
LARYNGOLOGIST AND RHINOLOGIST TO THE CINCINNATI HOSPITAL. 
In presenting this case to you, Mr. 
Chairman and gentlemen, I do not pre- 
sume to demonstrate it on account of its 
extreme rarity, or its peculiar and un- 
usual features; but my sole object is to 
show such a case to you before and 
after operation, to exhibit the results ob- 
tained by operative procedures, and to 
say a few words about the methods of 
treating cases of this kind. 
This gentleman, Mr. F. M., forty- 
two years of age, living in Indiana, is 
completely aphonic, as you will notice; 
otherwise he has the appearance of a 
man in the best of health. He found 
that he was getting hoarse about four- 
teen months ago. The hoarseness in- 
creased to complete aphonia within the 
past eight weeks. There was also some 
dyspnea, which has increased of late, 
especially when the patient exerts him- 
self in any way. A few days ago he 
consulted me, and I found a white, 
cauliflower-like sessile tumor, of oval 
shape and the size of a cherry, on the 
left vocal cord. The tumor had a rough 
surface, covered almost two-thirds of 
the cord, and extended downwards 
between the cords. A small tumor of 
the same character, the size of a pea, 
was seen on the right cord, near the 
anterior angle; and another similar one 
was seen in and below the anterior com- 
missure (Fig. i). Approximation of 
the cords was prevented by the foreign 
growths. At this time the patient was 
seen by several colleagues. About half 
of the tumor was removed at the first 
sitting by Krause’s laryngeal tube-for- 
ceps, which I will hand around, and 
which is an instrument admirably 
adapted to such operations. You will 
notice that I have been using in it a 
pair of small, oval, sharp spoons, which 
fit very accurately upon each other, and 
which allow you to use them also on 
very small particles of growth. There 
are, however, a number of different 
other instruments that fit in the same 
handle, as serrated forceps, snares, 
sharp double curettes, the latter es- 
pecially useful for the removal of infil- 
trated tissues in laryngeal tuberculosis. 
Fig. 1 
Those of you who have examined 
the patient with the laryngoscope have 
seen that there is at present a ragged, 
whitish mass, the size of a cherry stone, 
on the left cord; another white tumor 
on the right cord, and a third one situ- 
ated exactly in the angle of and some- 
what below the cords. The ragged 
tumor on the left cord shows distinctly 
the evidence of the operation, by numer- 
ous indentations. These remaining pieces 
APPEARANCE OF LARYNX BEFORE OPERATION. Multiple Papillomata of the Larynx—Thorner. 
of the tumors will also be removed; and 
while it is impossible to say whether his 
voice will be perfectly clear, I have no 
doubt that he will regain it to a great 
extent. I shall then take pleasure to 
present him to the Academy again. 
(Demonstration of instruments and 
presentation of patient.) 
SUPPLEMENTARY REPORT. 
OCTOBER 29, 1894. 
I desire to again present to the Acad- 
emy Mr. F. M., a patient whom I had the 
pleasure of presenting at the last meet- 
ing of the Academy during the summer 
season, about four months ago (see 
above report). As I mentioned at the 
time, the cauliflower-like appearance 
of the case, the circumstances connected 
with it and the appearance of the larynx 
pointed with almost absolute certainty 
to the diagnosis of papilloma of the 
larynx. The microscopic examination 
of the removed growth has verified this 
diagnosis. I have removed the rest of 
the tumors in a number of sessions, 
which were only interrupted for about 
five weeks during my vacation. The 
last operation was done about two 
weeks ago. Most of the masses were 
removed with the aid of Krause’s laryn- 
geal tube-forceps, demonstrated to you 
at the last meeting. However, at one 
time Voltolini’s sponge-instrument was 
used for the removal of a small piece of 
growth, the size of a pea, which was 
situated just in and below the anterior 
angle of the cords. This instrument 
consists of a strong laryngeal probe, to 
the bulb of which is firmly sewed a 
small, cylindrical piece of sterilized 
sponge. By energetic rubbing move- 
ments, executed, of course, under guid- 
ance of the laryngeal mirror, soft masses 
of growth can be readily destroyed. 
One large piece of tumor presented 
itself so nicely to the adaptation of the 
laryngeal snare, that I could not with- 
stand the temptation to remove it with 
this instrument. I desire to state here 
that, while I appreciate the advantage 
of being able to operate with as few 
instruments as possible, yet I know 
from experience that a variety of shapes 
and sizes of instruments for nice oper- 
ative work in the larynx, in the post- 
nasal space, and in the nose, is a great 
help to the surgeon. The exigencies of 
cases may be such, or the technique 
of the operation become so intricate, 
that it is utterly impossible to do the 
same good and accurate work with a 
few universal instruments. 
Those of you who will examine the 
larynx of this patient to-day, will find 
the following condition: There is yet 
some slight laryngitis present. No 
trace of the tumors can any where be 
seen. The vocal cords have perfectly 
clear edges and approximate nicely. 
During phonation you will notice that 
there is a very slight relaxation of the 
left cord, leaving in the middle of the 
Fig. 2 
APPEARANCE OF LARYNX A FEW DAYS AFTER 
OPERATION. 
cord a very small gap (Fig. 2.1) There is, 
however, as you will notice during deep 
inspiration, no excavation in the mass of 
the cord; it is nothing but a slight 
paresis of the inferior thyro-arytenoid 
muscle, as we see it often double-sided 
in any ordinary laryngitis, in which case 
we may have a button-hole gap between 
the cords. In this case it is simply a 
sign of the traumatic laryngitis, always 
following operative interference in the 
larynx, and it is to-day decidedly better 
i In this drawing the gap between the cords 
is somewhat exaggerated. At the time of the 
presentation of the patient it was much smaller; 
during phonation the edge of the left vocal cord 
was perfectly straight. Multiple Papillomata of the Larynx—ThornER. 
than it was a few days ago. It will 
disappear within a short time. The 
voice of the patient is loud, clear and 
firm; no trace even of hoarsness. I am 
told it is just as good as it was a year 
and a half ago, before he was affected. 
Regarding the general outcome of 
these cases, I wish to add that while it 
is usually not impossible to restore the 
voice, it is by no means safe to predict 
with certainty the degree of improve- 
ment which will result after the opera- 
tion. This is especially applicable in the 
case of singers. The question whether 
there is a liability of recurrence in these 
tumors may be thus answered, that 
while such a possibility exists, it is, as 
experience shows, not the rule, and one 
is almost in all cases sure to be able to 
eradicate them entirely. However, 
that these benign tumors should have a 
tendency to be transformed into malig- 
nant growths by operative interference, 
as has been from time asserted, 
is a theory not only not substantiated 
by authenticated facts, but actually dis- 
proved by the almost unanimous opinion 
of the vast majority of laryngologists. 
We may therefore safely"and conscien- 
tiously continue removing by intra-laryn- 
geal procedure such benign growths as 
cause at all inconvenience by interfering 
either with the voice or with unimpeded 
respiration. 
[For the drawings I am indebted 
to our efficient secretary, Dr. David 
DeBeck.] 
REPRINTED FROM THE 
CINCINNATI LANCET-CLINIC, 
November 17, 1894.