(Edema of Glottis 129 



epithelium below the false vocal cords ; above that it is squamous, 

 except in the lower half of the laryngeal aspect of the epiglottis, where 

 it is columnar ciliated. It contains many mucous glands, in some of 

 which the secretion may collect to form cystic tumours. About the 

 upper aperture the mucous membrane contains much loose connective 

 tissue, which becomes extensively infiltrated in oedema of the glottis. 



(Edema of the glottis may be caused by boiling water having 

 been swallowed, or by laryngitis ; the serous infiltration of the sub- 

 mucous tissue resembles that of oedema of the prepuce or eyelid. The 

 onset is marked by cough, hoarseness, and dyspnoea. Scarification of 

 the swollen tissue may give relief, or a soft catheter may be passed 

 along the floor of the nose, and through the glottis, by which respira- 

 tion may be carried on ; but the surgeon must always be in readiness 

 to open the windpipe below the obstruction. 



In acute laryngitis the vocal cords swell, and, vibrating amiss, 

 the voice becomes hoarse and the respirations noisy and difficult ; and 

 there is a 'brassy' cough. On account of the close proximity of the 

 pharynx, there is pain with deglutition. Unless relief be afforded, the 

 patient may die of suffocation ; indeed, laryngotomy or tracheotomy 

 may be early needed. 



Supply. The arteries are the superior and external laryngeal 

 branches of the superior thyroid, and branches of the inferior thyroid, 

 the blood being returned by the superior, middle, and inferior thyroid 

 veins. The lymphatics pass to the deep cervical glands. 



The nerves are the superior, and the recurrent laryngeal branches 

 of the vagi, and filaments from the sympathetic. The superior 

 laryngeals supply the mucous membrane, and give off the external 

 laryngeal branches for the crico-thyroidei, and twigs to the arytys- 

 noideus. The recurrent laryngeal supplies all the other muscles, and 

 gives additional filaments to the arytasnoideus. 



In making a laryngoscopic examination the observer should be 

 seated at a rather lower level than the patient ; the mirror should be 

 passed under the base of the uvula without having touched the tongue 

 or the pillars of the fauces, but even then its gentle application may 

 set up reflex vomiting (p. 70). The mirror being tilted, the epiglottis 

 is seen in its upper part, and the arytaenoid cartilages are seen in the 

 lower part ; but the vocal cord which is seen on the patient's right side 

 is actually the right cord. The cords appear white, and above them 

 are seen the false cords and the opening of the ventricle. The 

 arytaeno-epiglottidean folds are conspicuous objects ; the front of the 

 trachea is also seen, and possibly its division into the bronchi. Some- 

 times the wall of a thoracic aneurysm may be seen bulging into the 

 trachea. 



An opening- in the windpipe is needed when the laryngeal 

 air-way is seriously blocked. Among the chief signs of urgency are 

 a sinking-in of the supra-clavicular, supra-sternal, and epigastric 



K 



