Description of a Modified 
Laryngectomy. 
J. SOLIS-COHEK M. D. 
BY 
STije Web) Yorft if&etiical Souvnal 
REPRINTED FROM 
for June 18, 1887. Reprinted from the New York Medical Journal 
for June 18, 1887. 
DESCRIPTION OF 
A MODIFIED LARYNGECTOMY.* 
J. SOLIS-OOHEN, M. D. 
In many larynges removed entire or practically entire for 
carcinoma or for other disease rendering their retention 
perilous to the life of the individual, there has not been the 
slightest evidence of disease found in the thyroid carti- 
lages. It seems barbarous to me, therefore, other things be- 
ing equal, to remove these structures unnecessarily; the more 
that dangers from the operation, immediate and remote, 
are infinitely greater than when the cartilages can be left in 
their normal situation with the inferior constrictor muscles 
of the pharynx in position, and many other structures left 
undisturbed which, in complete laryngectomy, are necessa- 
rily injured, disturbed, and left exposed. The operation 
about to be described removes the entire respiratory por- 
tion of the larynx, leaving the greater portion of the pro- 
tecting thyroid cartilages undisturbed to perform their 
function as shields. As performed on the dead subject by 
myself and by Dr. Edward Martin, my chief of clinic in the 
laryngological department of the Philadelphia Polyclinic, 
* Read before the American Laryngological Association at its ninth 
annual congress. 2 
DESCRIPTION OF A MODIFIED LARYNGECTOMY. 
an exsection of the larynx, such as is shown in the specimen 
herewith exhibited, can he done within two minutes. The 
gap left in the body is insignificant in comparison to that 
following complete 'laryngectomy, and a firm support is re- 
tained for the accommodation of an artificial substitute for 
the parts removed. The operation will give sufficient access in 
many cases for removal of implicated portions of oesophagus 
and pharynx; and in cases of disease limited to the interior 
of the respiratory tube, or to the soft portions of the larynx, 
especially in cases not carcinomatous, it should fulfill every 
indication which has prompted entire laryngectomy, and 
without exposure to risks as great. It is applicable to the 
unilateral procedure as well as to the bilateral one. 
After I had performed this operation on the cadaver by 
several methods from above and below, and was desirous of 
determining which was the most expeditious and the readi- 
est, Dr. Martin kindly performed some twenty or more ad- 
ditional operations. 
Instruments required : a cartilage knife; a scalpel, me- 
dium size; a pair of strong cutting forceps, with narrow 
blades; blunt and sharp-pointed scissors; two strong blunt 
hooks, or retractors; volsellnm forceps, artery forceps, bull- 
dogs, dissecting and dressing forceps; tenacula; director, 
ligatures, sutures, needles. 
The following detailed steps in the operation are pre- 
sented by Dr. Martin and myself as the result of these in- 
vestigations : 
1. Make an incision from the hyoid bone to the lower 
border of the cricoid cartilage, and exactly in the middle line. 
2. Carefully separate the sterno-hyoid muscles, 
3. Hold the soft parts aside and insert, from above, one 
blade of a strong cutting forceps with narrow blades be- 
neath one wing of the thyroid cartilage, one fourth of an 
inch from the angle of junction with its fellowy and sever DESCRIPTION OF A MODIFIED LARYNGECTOMY. 
3 
the cartilage vertically its entire length through to the 
crico-thyroid membrane. 
4. Make a similar cut on the opposite side. 
5. Seize the freed angular portion of the thyroid carti- 
lage, comprising its entire respiratory contingent, with a 
volsellum forceps and draw it to either side, the soft parts 
being separated meanwhile from the inner surfaces of the 
detached wings of the thyroid cartilages with the handle 
of the scalpel. 
6. Make a transverse cut to sever the cricoid cartilage 
from the trachea. (At this step, in the living subject a 
sterilized cotton plug should be inserted into the upper end 
of the trachea, preliminary tracheotomy having been per- 
formed previously.) 
Note.—lf the cricoid cartilage is to be retained, disarticulate the 
arytenoids, and then sever the soft parts above the cricoid instead of 
below. This modifies the next step in the procedure accordingly. 
7. Lift the cricoid cartilage forward and carefully sepa- 
rate it with the edge of the knife from the inferior cornua 
of the thyroid, laterally and superiorly, and then from the 
oesophagus posteriorly. 
8. Insert a finger into the pharynx from below and carry 
its tip over the epiglottis to draw that structure down. 
9. Divide the thyro-hyoid membrane and the fibrous 
tissues still holding. 
10. Lift out the exsected respiratory portion of the 
larynx. 
The arteries likely to require ligation will comprise 
small branches of the superior, middle, and inferior laryn- 
geals. 
Upon the Jiving subject the operation should be strictly 
aseptic, and where practicable should have been preceded 
by several days by a preliminary tracheotomy. The trachea 
may be occluded superioi’ly by a small rubber bag attached 4 
DESCRIPTION OF A MODIFIED LARYNGECTOMY. 
to the smallest-sized soft catheter, introduced through the 
tracheal wound, above the cannula, and then inflated. The 
cannula may be temporarily removed during the introduc- 
tion of the bag and its inflation. 
Advantages alleged for this procedure : 
1. Its rapidity, ease, and comparative safety to the pa- 
tient. 
2. The small size of the wound. 
3. The preservation of the attachments of the thyro- 
hyoid ligament and the greater part of the membrane, and 
of the thyro-hyoid, sterno-thyroid, stylo-pharyngeus, and 
inferior constrictor muscles ; leaving— 
4. Important functional structures retained in their nor- 
mal relations for deglutition ; and leaving— 
5. A firm, natural support for the adjustment of arti- 
ficial substitutes for the larynx. 
For these reasons it is submitted that this procedure 
should be preferred to complete laryngectomy whenever 
not precluded by extent of disease. REASONS WHY 
Physicians shoulA Merits 
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