Whatever the procedure chosen for the operation, preliminary tracheotomy is a prerequisite.

It should be made well below the isthmus of the thyroid gland, and from three to fifteen days before the laryngectomy.

This affords time for the lungs to become accustomed to the new manner of breathing, and the trachea becomes fixed to the anterior wall of the neck.
Powers and White have gathered 69 cases of either total or partial extirpation of the larynx, to which the 240 cases collected and analyzed by Eugene Kraus, in 1890, have been added.

The histories of six new cases are given.

Of the 309 operations, 101, or 32 per cent of the patients, died within the first eight weeks from shock, hemorrhage, pneumonia, septic infection, or exhaustion.