_Methods of Treatment_.--Irritating applications probably provoke
recurrences, because the growths are of inflammatory origin. Formerly
laryngostomy was recommended as a last resort when all other means had
failed. The excellent results from the method described in the
foregoing paragraph has relegated laryngostomy to those cases that
come in with a severe cicatricial stenosis from an injudicious
laryngofissure; and even in these cases cure of the stenosis as well
as the papillomata can usually be obtained by endoscopic methods
alone, using superficial scalping off of the papillomata with
subsequent laryngoscopic bouginage for the stenosis. Thyrotomy for
papillomata is mentioned only to be condemned. Fulguration has been
satisfactory in the hands of some, disappointing to others. It is
easily and accurately applied through the direct laryngoscope, but
damage to normal tissues must be avoided. Radium, mesothorium, and the
roentgenray are reported to have had in certain isolated cases a
seemingly beneficial action. In my experience, however, I have never
seen a cure of papillomata which could be attributed to the radiation.
I have seen cases in which no effect on the growths or recurrence was
apparent, and in some cases the growths seemed to have been stimulated
to more rapid repullulations. In other most unfortunate cases I have
seen perichondritis of the laryngeal cartilages with subsequent
stenosis occurring after the roentgenotherapy. Possibly the disastrous
results were due to overdosage; but I feel it a duty to state the
unfavorable experience, and to call attention to the difference
between cancer and papillomata. Multiple papillomata involve no danger
to life other than that of easily obviated asphyxia, and it is
moreover a benign self-limited disease that repullulates on the
surface. In cancer we have an infiltrating process that has no limits
short of life itself.
Public-domain text, read in full here on John Shaqi.
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