in connection with other forms of stenosis of the air
passages.

_Aphonia_ due to cicatricial webs of the larynx may be cured by
plastic operations that reform the cords, with a clean, sharp anterior
commissure, which is a necessity for clear phonation. The laryngeal
scissors and the long slender punch are often more useful for these
operations than the knife.

[224] CHAPTER XXIX--BRONCHOSCOPY IN DISEASES OF THE TRACHEA AND
BRONCHI

_The indications for bronchoscopy in disease_ are becoming
increasingly numerous. Among the more important may be mentioned:
1. Bronchiectasis.
2. Chronic pulmonary abscess.
3. Unexplained dyspnea.
4. Dyspnea unrelieved by tracheotomy calls for bronchoscopic search
for deeper obstruction.
5. Paralysis of the recurrent laryngeal nerve, the cause of which is
not positively known.
6. Obscure thoracic disease.
7. Unexplained hemoptysis.
8. Unexplained cough.
9. Unexplained expectoration.

_Contraindications to bronchoscopy in disease_ do not exist if the
bronchoscopy is really needed. Serious organic disease such as
aneurysm, hypertension, advanced cardiac disease, might render
bronchoscopy inadvisable except for the removal of foreign bodies.

_Bronchoscopic Appearances in Disease_.--The first look should note
the color of the bronchial mucosa, due allowance being made for the
pressure of tubal contact, secretions, and the engorgement incident to
continued cough. The carina trachealis normally moves slowly forward
as well as downward during deep inspiration, returning quickly during
expiration. Impaired movement of the carina indicates peritracheal and
peribronchial pathology, the fixation being greatest in advanced
cancer. In children and in the smaller tubes of the adult, the
lengthening and dilatation of the bronchi during inspiration, and
their shortening and contraction during expiration are readily seen.

_Anomalies of the Tracheobronchial Tree_.--Tracheobronchial anomalies
are relatively rare. Congenital esophagotracheal and esophagobronchial
fistulae are occasionally seen, and cases of cervicotracheal fistulae
have been reported. Congenital webs and diverticula of the trachea are
cited infrequently. Laryngoptosis and deviation of the trachea may be
congenital. Substernal goitre, aneurysm, malignant growths, and
various mediastinal adenopathies may displace the trachea from its
normal course. The emphysematous chest fixed in the deep voluntary
inspirat