ARYTENECTOMY. 65 



subjacent muscular tissue being careful to follow the median 

 line exactly until the crico-thyroidean ligament, CTL, Plate 

 XI, the cricoid cartilage C, and the first tracheal ring TRI, 

 are laid bare. Again control any hemorrhage. Plunge the 

 scalpel with its cutting edge directed backward through the 

 crico-thyroidean ligament on a level with the dotted line T 

 and extend this backward along the median line severing the 

 cricoid cartilage, C, and the first tracheal ring, TRI. Insert 

 the retractors and have the larynx held well open by as- 

 sistants. Illuminate the larynx by means of a reflecting 

 lamp as may be required. After controlling any hemorrhage 

 caused by the foregoing make an incision through the mucosa 

 and the intervening connective tissue between the two 

 arytenoid cartilages, A, beginning at the anterior part and 

 extending backward to the cricoid, thence turning upward 

 and laterally, incise the mucosa across the posterior end of the 

 arytenoid thence forward along its lateral border through 

 the vocal cord, V, and turning downward as the animal lies, 

 that is toward the dorsal part of the larynx, continue the 

 incision to the point of beginning. In making this incision 

 cut as closely as possible to the margin of the cartilage so 

 that a minimum amount of the mucous membrane will be 

 removed. Grasp the lateral border of the cartilage with 

 the long tenaculum forceps and with the razor-shaped knife 

 or the scissors separate the lateral and anterior portions of 

 it from the adjacent tissues keeping always immediately 

 against it in order to produce as clean a wound as possible 

 and to avoid injuring adjacent vessels from which hemor- 

 rhage would occur. 



When the cartilage has been detached over the greater part 

 of its surface locate the crico-arytenoid articulation and dis- 

 articulate or cut through the arytenoid as close to the articu- 

 lation as possible with the razor-shaped knife or the scissors. 

 Remove all blood by means of pledgets of absorbent cotton 

 securely held in the long dressing forceps, or the clots may 



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