ultimate vocal results
are good. Evisceration of the larynx, either by the endoscopic or
thyrotomic method, usually yields excellent results when no lesion
other than paralysis exists. Only too often, however, the condition is
complicated by the results of a faultily high tracheotomy. A rough,
inflexible voice is ultimately obtained after this operation,
especially if the arytenoid cartilage is unharmed. In recent bilateral
recurrent paralysis, it may be worthy of trial to suture the recurrent
to the pneumogastric. Operations on the larynx for paralytic stenosis
should not be undertaken earlier than twelve months from the inception
of the condition, this time being allowed for possible nerve
regeneration, the patient being made safe and comfortable, meanwhile,
by a low tracheotomy.

_Ankylosis_.--Fixation of the crico-arytenoid joints with an
approximation of the cords may require evisceration of the larynx.
This, however, should not be attempted until after a year's lapse, and
should be preceded by attempts to improve the condition by endoscopic
bouginage, and by partial corking of the tracheotomic cannula.

_Neoplasms_.--Decannulation in neoplastic cases depends upon the
nature of the growth, and its curability. Cicatricial contraction
following operative removal of malignant growths is best treated by
intubational dilatation, provided recurrence has been ruled out. The
stenosis produced by benign tumors is usually relieved by their
removal.

_Papillomata_.--Decannulation after tracheotomy done for papillomata
should be deferred at least 6 months after the discontinuance of
recurrence. Not uncommonly the operative treatment of the growths has
been so mistakenly radical as to result in cicatricial or ankylotic
stenoses which require their appropriate treatments. It is the
author's opinion that recurrent papillomata constitute a benign
self-limited disease and are best treated by repeated superficial
removals, leaving the underlying normal structures uninjured. This
method will yield ultimately a perfect voice and will avoid the
unfortunate complications of cicatricial hypertrophic and ankylotic
stenosis.

_Compression Stenosis of the Trachea_.--Decannulation in these cases
can only follow the removal of the compressive mass, which may be
thymic, neoplastic, hypertrophic or inflammatory. Glandular disease
may be of the Hodgkins' type. Thymic compression yields readily to
radium and the roentgenray, and the tubercu