History of the treatment of carcinoma of the larynx

The development the treatment of carcinoma of the larynx is closely linked with the development of the diagnostics of this cancer. Examination of the larynx was not always for granted. The indirect technique of examining the larynx with the aid of a dentistry mirror (1) was only developed by Manuel Garcia in the middle of the 19th century. The first direct laryngoscopy was performed by Alfred Kirstein in 1895. It was not the examination performed with today’s instruments and technology but it allowed a previously impossible direct look into the larynx (14). Microscopic diagnosis of the illness was first described in the mid 19th century by Virchow (26). Even so, many ill people continued to die from undiagnosed carcinoma of the larynx and several unnecessary laryngectomies were performed on patients with a false positive diagnosis of carcinoma of the larynx. An idea of the state of affairs at the end of the 19th century is given by the example of the Prussian Crown Prince, late Emperor Frederick III of Germany. Despite the fact that his examinations and treatment were conducted by the top doctors of the time, led by Morell Mackenzie (22), who relied on Virchow’s histological examination, Frederick died within two years due to an originally small tumour of the left vocal cord. Problems with stating a diagnosis, during which perichondritis of the cartilage of the larynx and syphilis were considered, as well as, delays in treatment and squabbles between the participating experts indirectly led to the development of world events. The death of the liberal Frederick, who dreamed of democracy, led to the government of Emperor William II., who led Germany into World War I. Difficulties in differential diagnosis between carcinoma of the larynx, tuberculosis and syphilis were significantly reduced with the works of Koch who discovered the Koch bacillus in 1882 and by Wassermann, who introduced a test for syphilis in 1906. Until then otolaryngologists had to rely on their own clinical experience and often had to operate without a previous biopsy (21). The development of the treatment of carcinoma of the larynx went through various stages (11). After an initial period of blundering and primary experiences, a period of radical surgical treatment began. The most common treatment of the time for carcinoma of the larynx was a total laryngectomy. In the next phase, doctors concentrated on saving the function of the larynx, especially the voice, while adhering to the principles of oncological safety and radicalism (the partial laryngectomy period). These principles have also been accepted by the current period and have been added to the effort to retain a functional larynx, even in cases of widespread tumours which would have to be treated surgically with a total laryngectomy (the combined