32 CLINICAL VETERINARY MEDICINE AND SURGERY. 



incise the laryngeal mucous membrane along the superior and posterior 

 margins of the arytaenoid a little within their borders. As a dressing 

 I place in the larynx two rectangular, flattened tampons of gauze on 

 edge, which I fix by passing through them the silk threads of the 

 suture used to unite the muscle. I remove the dressing and tracheo- 

 tomy tube at the end of twenty-four hours. For the first few days I 

 keep the trachea open and the wound exposed, by passing through 

 the centre of the skin and muscle forming the lips of the wound two 

 threads, which are tied together above the neck. Whilst sparing 

 the mucous membrane covering the superior and posterior margins 

 of the arytsenoid as much as possible, I slightly changed, though 

 I ought to say without much benefit, the method of removing the 

 cartilage. In certain cases I preserved a narrow band of the mucous 

 membrane covering the anterior margin of the cartilage. In others, 

 where the larynx was particularly narrow, I made the incision opposite 

 the inferior margin of the arytaenoid a little larger, extending it to 

 the mucous membrane and the upper part of the vocal cord. In 

 others, again, I removed the greater part of the articular angle of 

 the arytaenoid with cutting forceps. Except for this latter modifica- 

 tion, I consider it very important to limit as far as possible the area 

 of incisions in the laryngeal mucous membrane ; not to extend 

 towards the region of the oesophagus when detaching the upper 

 surface of the arytsenoid ; and not to wound either the portion of the 

 arytsenoid left or the vocal cord. 



With a little practice the manipulations in arytaenoidectomy are 

 easity performed, even without anaesthesia ; but these manipulations 

 cannot be carried out correctly, or with the necessary certainty, by an 

 unpractised or clumsy hand. 



When the wound resulting from ablation of the arytaenoid heals 

 regularly, when granulation is not excessive or new cicatricial tissue 

 exuberant, the entrance to the larynx remains enlarged ; the result 

 is then good. 



In favourable cases the course of events is as follows : — The 

 mucous membrane at the four margins of the wound left by removal 

 of the arytaenoid is far from being equally moveable ; the superior and 

 inferior margins of this wound cannot be united by suture, but it is 

 easy to bring the anterior and posterior in contact without dissection 

 and without tearing ; the reason being that the anterior edge is very 

 moveable and can easily be drawn towards the posterior, thus covering 

 the whole wound. If left to itself the wound granulates over its entire 

 surface, and the cicatricial tissue in contracting draws the anterior 

 margin much nearer the centre than it does the others. It is the 



