THE SURGICAL principles presented in this paper have made it possible to remove almost the entire larynx and yet retain a normal airway. In all such efforts directed toward the same end—andthere have been many in the past—three technical surgical problems exist, consisting of the need to create a lining, to provide a lumen, and to lend rigidity.
In the technique under discussion, all three have been taken into consideration. For a lining, the external perichondrium of both alae of the thyroid cartilage is preserved and retained in toto, a concept borrowed from St. Clair Thomson's description of hemilaryngectomy. There is precedence for this even in total laryngectomy, since the so-called closed-field method which does not remove this membranous sheet has been an accepted technique for many years. The method of providing a lumen is the old established one of a temporarily retained obturator. The plan for providing rigidity is