208 
LARYNGOTOMY. 
it is necessary to follow carefully the borders of the cartilage, holding 
the latter with a pair of lion forceps (fig. 102). Throughout the operation 
the larynx must be cleared of blood by the use of small sponges fastened 
to thin sticks, and wielded by an assistant; and in the same way the 
field of operation must be cleared after removal of the arytenoid itself. 
Bleeding is usually slight, though in rare cases a spurting vessel may 
require to be closed by torsion. After bleeding is somewhat checked, 
the surface of the wound is swabbed with 10 per cent, chloride of zinc 
Fig. 101.—Curved scissors. 
Fig. 102.—Forceps 
for grasping tlie 
arytenoid. 
Fig. 103.—Curved needle 
for suturing laryngeal 
mucous membrane. 
solution applied with a sponge, and is then powdered with 1 of iodoform 
to 8 of tannin. 
More recently Moller attempted to stitch the mucous membrane, using 
a curved needle (fig. 108). It can be very well managed after a little 
practice. The needle, threaded with catgut, is first passed through the 
upper fold of the membrane, which is then drawn downwards and 
fastened to the under border of the wound. Silk should be avoided, as 
in the larynx it remains unabsorbed for months. Three sutures usually 
suffice to fix the membrane in position, to assist cicatrisation, and prevent 
the loose plicae aryepiglotticae interfering with breathing after healing. 
Removal of the vocal cord is unnecessary and injurious. A tampon 
properly fitting the larynx, or a Trendelenberg canula, is introduced and 
adjusted. To secure the tampon and tube a couple of temporary sutures 
are passed through the skin, and two pieces of tape over the seat of 
operation and round the neck. 
