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2 4
KAEMPFER: SUSPENSION LARYNGOSCOPY.
1 New York
,\I I DIGeneric Thorazine in the direct laryngoscopy are met with
here. A great deal depends upon the tongue. A
short, thick tongue, especially when the surface is
much curved from side to side, usually baffles the
operator. It is difficult and sometimes impossible
to keep the spatula from slipping off sidewise. A
thick tongue, too, cannot always be sufficiently de-
pressed into the floor of the mouth to give a good
view of the larynx. Sometimes the epiglottis slips
off the end of the spatula. This is overcome by sub-
stituting a longer spatula. Often a good picture
cannot be obtained because the tongue has been
pulled out too far. The tip of the tongue need not
be brought further out than the edge of the teeth.
When difficulties are encountered in the introduc-
tion of the spatula, or where a good picture cannot
be obtained, Killian recommends the use of a
shorter spatula and its introduction Thorazine Bipolar from the angle
of the mouth. Only half the tongue can be de-
pressed Thorazine Iv and the field is much narrower than when
the spatula lies in the middle line.
ADVANTAGES.
The two main points in favor of suspension
laryngoscopy as a rational procedure are: Purchase Thorazine Online First,
the larynx is brought so near to the operator that Order Thorazine
manipulations are permitted that Buy Thorazine would be impos-
sible with any other method of approach ; second,
the operator has both hands free with which to Thorazine 200 Mg
work instead of one as in all other methods. An-
other great advantage of suspension laryngoscopy
is that secretions and blood tend to flow toward the
pharyngeal roof which is the most dependent part. Thorazine 25 Mg
The opening of the larynx being in direct line of
vision can easily be sponged free of blood and se-
cretions. This enables the operator to make a
longer and more thorough examination and to do
more complete operations. He can, for instance,
remove in one sitting small and not easily acces-
sible growths or curette the larynx entirely free of
tuberculous granulations.
THE LARYNGEAL PICTURE.
The picture in suspension laryngoscopy is exten-
sive. One sees directly into the larynx. The epi-
glottis, of course, is not Thorazine 10 Mg seen, being covered by the
spatula. The oropharynx and the relations of the
pharynx and larynx are well shown.
The first portion of the larynx to be seen is the
posterior wall. The cords are in the cadaveric po-
sition. If the spatula is too broad it may be dif-
ficult to get a view of the anterior commissure. The
substitution of a narrow spatula and pressure on
the larynx externally, as suggested by Briinings,
will usually bring the entire larynx into view.
CLINICAL OBSERVATIONS.
The malady that lends itself most readily to treat-
ment in the suspended position is tuberculous laryn-
gitis. Granulations can be completely removed at
one sitting. Infiltrations can be easily treated with
galvanocautery. Smaller and larger growths in the
larynx can be readily attacked in this position.
Bleeding is easily controlled. Foreign bodies in the
larynx are not difficult of removal.
The extirpation of pharyngeal growths, such as
fibromata on the roof of the pharynx, is facilitated
by this position. The writer saw Killian remove a
large fibroma from the pharyngeal roof of a boy
of twelve years. In his hands and in this position,
this exceedingly bloody and difficult procedure was
quickly and skillfully done, and the patient made an Buy Cheap Thorazine
uneventful recovery.
Killian reports fifty cases in which he has used
the suspension laryngoscopy without untoward re-
sults other than slight traumata of the pharyngeal
wall or epiglottis, or an occasional squeezing of the
tongue between the instrument and the incisor teeth.
The latter accident can be avoided by placing a
small cotton pad on the tongue.
The scopolamine morphine narcosis was satisfac-
tory in almost every case. In only two was a gen-
eral anesthetic used. Applications of twenty per
cent, cocaine were made in Purchase Thorazine most cases. The major-
ity of the patients were young men between the
ages of twenty and thirty years, although there was
a goodly number of women and children. In even-
case the procedure was well tolerated, and none of
the patients complained of pain on the next day, al- Thorazine 100 Mg
though several were suspended for considerable
lengths of time.
Clinically the cases fall into two main groups ;
those with tuberculous laryngitis and those with
papillomata. Several of the tuberculous cases Chlorpromazine Thorazine
were operated in twice, but most of them were Thorazine Price
curetted only once. All cases with ulcers or granu-
lations were curetted thoroughly and the clean
bases rubbed with lactic acid or iodoform powder.
The infiltrations were cauterized with the galvano-
cautery.
There was a rise of temperature following the
curettement, usually of short duration. Killian Thorazine Chlorpromazine re-
marks that his tuberculous patients tolerated mor-
phine scopolamine injections much better than they
did general anesthesia. Bleeding was easily con-
trolled.
Papillomata of the larynx occurred mainly in

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