Thyrotomy in the Treatment of Laryngeal Cancer
Authors: W. Stokes
Journal: BMJ (1889)

most active, and which were exposed to irritation and pressure that most frequently suffered from perichondritis, whether primary or secondary.Further, it was in elderly people, when there was more or less tendency to ossification, that perichondritis was usually seen.It had been alleged that intralaryngeal manipulations were Inot an infrequent cause of perichondritis; in the speaker's opinion suclh cases must be very exceptional, and for his part he had never seen one or seen one recorded.-Mr. LENNOx BROwNVN was of opinion that cases of primary peri- chondritis was exceedingly rare; and he could only recall one case of the simple nature, of which he felt no doubt, namely, that of a boy who was attacked after going to sleep when in a state of perspiration in a hay field, exposed to an east wind.With regard to diagnosis, he did not attach so much importance as Dr. Hall to inter-arytenoid infiltration as distinguishing tuberculous peri- chondritis from syphilitic, because that situation was a very favourable one for syphilitic gummata.There was, however, as a rule, far more hyperaemia in syphilitic cases than in the tuber- culous.A very early symptom, and one of great diagnostic im- portance, was subglottic swelling of the vocal cord of the effected side.Difficulty and pain in swallowing, without presence of new growth or of ulceration (malignant), or of swollen epiglottis (tubercular), were of high diagnostic importance.lie thought that abscess in the case of cancer of the larynx was rare, and also that enlarged cervical glands but very rarely suppurated in this disease.He doubted over-exertion of the voice as a cause of laryn- geal perichondritis, and believed that unilateral inflammation of one vocal cord, especially when recurrent, was almost invariably due to syphilis.He would not admit elimination of a syphilitic dys- crasia by negative results obtained from administration of iodide of potassium alone, but only after a steady course of mercury, either internally or by inunction, had been pursued without effect.In his experience the cartilage most frequently affected was the cricoid in its posterior aspect; next the arytenoid and crico- arytenoid articulations.Doubtless Dr. Spicer's remarks as to irritation of food, predisposed in some cases to the preference of this situation for benign perichondrial inflammations, were correct; the same, indeed, obtained in malignant disease.-ThePRESIDENT said he thought a great distinction should be made between two conditions of perichondritis which Dr. Hall had classed together, namely, that which occurred in the course of the advance of cancer, and which depended on the extension of the primary disease to or through the perichondrium; and the perichondritis -which occurred in association with, or as a sequel to, typhoid and *other fevers.In this form of perichondritis there was not usually any previous affection of the larynx, and the inflammation ap- peared, so to speak, to fall bodily on the cartilage or its covering ,as tissues specially liable to be affected by the poison of the primary disease.This was the more curious when it was taken 'into account how very rare a disease periclhondritis was in the human body.There was quite a large area of perichondrium covering the tarsal cartilages, the pinna of the ear, the nasal and laryngeal cartilages, and the cartilages of the ribs.But inflam- mation of the perichondrium covering any of these structures, un- less it were that covering the cartilages of the larynx, was scarcely ever met with.Yet several of the parts covered with perichon- drium were much exposed to cold and injury.The rarity of ;perichondritis was the more singular when it was taken into account how frequent inflammation of the periosteum was in *certain situations.Taking all these circumstances into considera- tion, he quite agreed with Mr. Browne that every case of simple primary perichondritis of the larynx should be regarded with sus- picion, and should only be admitted in the absence of every pre- *disposing cause such as syphilis, fever, and the like.