The present methods of arytenoidectomy and lateral suture of the corresponding cord used in the surgical treatment of double abductor paralysis of the vocal cords presents a serious dilemma. When the cord is displaced laterally sufficiently to give satisfactory respiration the voice is seriously defective. Thus the surgeon must decide between satisfactory respiration or
Brooch to conceal tracheotomy tube: A, closed; B, open, for removal and cleaning of inner tube. a satisfactory voice. The two functions of the larynx cannot be maintained at the same time by this operation whatever the route adopted to reach the arytenoid. The same statement applies to the Lore operation, performed through a laryngofissure. There is only one procedure which will give at the same time a satisfactory voice and free respiration. That is a tracheotomy with the insertion of a valved tube. After a tracheotomy and the use of such a tube, the respiration