s to be to split the food bolus and direct its portions laterally
into the pyriform sinuses, rather than to take any important part in
the closure of the larynx. Following the removal of the epiglottis
there is rarely complaint of food entering the larynx. The projecting
portion of the epiglottis may be amputated with a heavy snare, or by
means of the large laryngeal punch forceps (Fig. 33).

_Endoscopic Operations for Laryngeal Stenosis_.--Web formations may be
excised with sliding punch forceps, or if the web is due to
contraction only, incision of the true band may allow its retraction.
In some instances liberation of adhesions will favor the formation of
adventitious vocal cords. A sharp anterior commissure is a large
factor in good phonation.

_Endoscopic evisceration of the larynx_ will cure a few cases of
laryngeal cicatricial stenosis, and should be tried before resorting
to laryngostomy. A sliding punch forceps is used to remove all the
tissue in the larynx out to the perichondrium, but care should be
taken in cicatricial cases to avoid removing any part of either
arytenoid cartilage. In cases of posticus paralysis the excision may
include portions of the vocal processes of the arytenoids.
Ventriculocordectomy is preferable to evisceration. The ventricular
floor is removed with punch forceps (Fig. 33) first on one side, then
after two months, on the other.

_Vocal Results_.--A whispering voice can always be had as long as air
can pass through the larynx, and this may be developed to a very loud
penetrating stage whisper. If the arytenoid motility has been
uninjured the repeated pulls on the scar tissue may draw out
adventitious bands and develop a loud, useful, though perhaps rough
and inflexible voice.

_Galvano-cauterization_ is the best method of treatment for chronic
subglottic edema or hyperplasia such as is seen in children following
diphtheria, when the stenosis produced prevents extubation or
decannulation. The utmost caution should be used to avoid deep
cauterizations; they are almost certain to set up perichondritis which
will increase the stenosis. Some of the most difficult cases that have
come to the author have been previously cauterized too deeply.

_Galvano-cautery puncture_ of tuberculous infiltrations of the larynx
at times yields excellent results in cases with mild pulmonary
lesions, and has quite replaced the use of the curette, lactic acid,
and other caustics. The direct method of ex