ARYTENECTOMY. 69 



Again control any hemorrhage. Phuige 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. In- 

 sert 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 hemor- 

 rhage 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 turn- 

 ing 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 down- 

 ward 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 a razor-shaped knife or the scissors separate the lateral 

 and anterior portions of it from the adjacent tissues keep- 

 ing always immediately against it in order to produce as 

 clean a wound as possible and to avoid injuring adjacent 

 vessels from which hemorrhage 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 clo.se 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 

 be pushed into the pharynx when they will generally be 

 swallowed. Carefully remove any cartilaginous remnants 

 or tissue shreds and control the hemorrhage from any 



