206 
LARYNGOTOMY. 
. Crico-tracheotomy, as adopted in the treatment of hemiplegia laryngis, 
was fully described in the brochure published by Moller in 1888. 
The animal is chloroformed and placed on its back; the operator 
kneels on the right side of the neck, shaves the hair from the larynx and 
upper portion of the trachea, and disinfects the site of operation. The 
position of the cricoid cartilage is easily determined by palpation. An 
incision, exactly in the middle line, is made through the skin, extending 
from the body of the cricoid cartilage as far as the first two or three 
rings of the trachea. After ligaturing any bleeding vessels, the muscles 
lying below the skin are divided exactly in the middle line. The 
trachea and cricoid cartilage are thus exposed with scarcely any 
bleeding, but any vessel spurting must at once be ligatured. A 
tampon-canula (Trendelenberg canula) 
provided with a bellows is held in readi¬ 
ness. An incision is made through the 
first two rings of the trachea with a 
pointed bistoury, turning the cutting edge 
towards the animal’s head, and extending 
the opening by carrying the knife up to 
the thyroid cartilage. In case of vessels 
bleeding at this stage, the tampon-canula 
should be inserted, inflated with air, and 
the vessels ligatured. Entrance of blood 
into the trachea must in any case be pre¬ 
vented. The wound is now held open 
with a pair of blunt hooks or retractors, 
and after removal of any blood, the 
interior of the larynx can be seen. 
Where tumours have to be excised, 
little difficulty is encountered, if their 
bases are not broad. Resection of the 
vocal cords has already been described. Where there is paralysis of 
the recurrent, the arytenoid cartilage on the paralysed side is removed. 
While Gunther and Stockfleth practised partial resection, Mdller pro- 
Fig. 98.—Moller’s operation. Vertical 
and antero-posterior section of the 
larynx. The dotted line represents 
the mucous membrane covering the 
edges of the arytenoid cartilage. 
posed total removal of this cartilage, and still prefers this method. 
With a specially-constructed scalpel (fig. 99), the mucous membrane 
at the periphery of the arytenoid cartilage is divided. Beginning at 
the point of union of the arytenoid cartilages, the knife, carried 
through the mucous membrane and the interarytenoid ligament in an 
upward direction, close beside the middle line, follows the posterior 
border of the arytenoid cartilage upwards as far as the vocal pro¬ 
cess (in fig. 100 the dotted line shows the course of the incision). 
I he vocal cord is divided with scissors at its point of union with 
