removal.

_Papillomata in the larynx of adults_ are, on the whole, much more
amenable to treatment than similar growths in children. Tracheotomy is
very rarely required, and the tendency to recurrence is less marked.
Many are cured by a single extirpation. The best results are obtained
by removal of the growths with the laryngeal grasping-forceps, taking
the utmost care to avoid including in the bite of the forceps any of
the subjacent normal tissue. Radical resection or cauterization of the
base is unwise because of the probable impairment of the voice, or
cicatricial stenosis, without in anyway insuring against
repullulation. The papillomata are so soft that they give no sensation
of traction to the forceps. They can readily be "scalped" off without
any impairment of the sound tissues, by the use of the author's
papilloma forceps (Fig. 29). Cutting forceps of all kinds are
objectionable because they may wound the normal tissues before the
sense of touch can give warning. A gentle hand might be trusted with
the cup forceps (Fig. 32, large size.)

Sir Felix Semon proved conclusively by his collective investigations
that cancer cannot be caused by the repeated removals of benign
growths. Therefore, no fear of causing cancer need give rise to
hesitation in repeatedly removing the repullulations of papillomata or
other benign growths. Indeed there is much clinical evidence elsewhere
in the body, and more than a little such evidence as to the larynx, to
warrant the removal of benign growths, repeated if necessary, as a
prophylactic of cancer (Bibliography, 19).

[207] CHAPTER XXIII--BENIGN GROWTHS PRIMARY IN THE TRACHEOBRONCHIAL
TREE

Extension of papillomata from the larynx into the cervical trachea,
especially about the tracheotomy wound, is of relatively common
occurrence. True primary growths of the tracheobronchial tree, though
not frequent, are by no means rare. These primary growths include
primary papillomata and fibromata as the most frequent, aberrant
thyroid, lipomata, adenomata, granulomata and amyloid tumors.
Chondromata and osteochondromata may be benign but are prone to
develop malignancy, and by sarcomatous or other changes, even
metaplasia. Edematous polypi and other more or less tumor-like
inflammatory sequelae are occasionally encountered.

_Symptoms of Benign Tumors of the Tracheobronchial Tree_.--Cough,
wheezing respiration, and dyspnea, varying in degree with the size of
the tumor, indicat