File:The principles and practice of surgery (1916) (14761841074).jpg

Identifier: principlespracti1916warr (find matches)
Title: The principles and practice of surgery
Year: 1916 (1910s)
Authors: Warren, Richard, 1876-
Subjects: Surgery Surgery
Publisher: Philadelphia : Lea & Febiger
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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n with the laryngoscope. The treatment is specific forgeneralized syphilis. In the tertiary stage gummata occur in the epiglottis,aryepiglottidean folds, and interior of the larynx ; ulceration is common,the ulcers having the characteristic appearance of tertiary ulcere, beingpunched out with hypersemic surroundings, a yellow, sloughy floor andabsence of glandular enlargement. Where these ulcers spread rapidlyperichondritis results, which is later followed by cicatricial contraction and SYPHILIS OF THE LARYNX 469 stenosis of the larynx in severe or neglected cases. The usual signs arehoarseness and dyspnoea, laryngeal obstruction being common, whiledysphagia is much less usual than in tuberculous ulceration : on examinationthe ulcers and infiltrations are seen (Fig. 159). Diagnosis from tuberculous ulcers is made by the well-defined edge ofthe ulcer and surrounding redness, contrasting with the gnawed edge andsurrounding pallor or tubercle, by the epiglottis being especially affected,
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Fig. 159. Tertiary syphilis of the larynx. Ulceration and cicatricial contrac-tion involving the epiglottis, vocal cords, aryepiglottidean folds. by the absence of dysphagia, while the general condition is good and nosigns are present in the lung or tubercle bacilli in the sputum. From cancer by the more rapid progress of the ulceration without wartyoutgrowths, seldom commencing from the cords, by the special involve-ment of the epiglottis and the multiplicity of the ulcers often noted. Indoubtful instances pieces should be removed for microscopical investigation. Treatment. This is specific with neosalvarsan, iodides, and mercury;treacheotomy is often needed where there is oedema or perichondritis, andit should be noted that administration of specific remedies may set uptemporary but severe oedema and should only be administered in severecases when the patient is under supervision, so that tracheotomy may bedone speedily if required. The resulting stenosis is discussed later. 470 A T

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