A new technique to expose the hypopharyngeal space: The Modified Killian's method

Sakai, Akihiro; Okami, Kenji; Sugimoto, Ryousuke; Ebisumoto, Koji; Yamamoto, Hikaru; Maki, Daisuke; Saito, Kosuke; Iida, Masahiro

doi:10.1016/j.anl.2013.10.012

Cited by 36 publications

(27 citation statements)

References 5 publications

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“…Recent data show that this proportion of patients can be further increased up to 85% by a maneuver described by Sakai et al [6, 13] as the modified Killian’s method. For this method, Murono et al [9] indicate a visibility score of up to 3.6 in a group of 57 patients who had been followed up for hypopharyngeal or laryngeal disease.…”

Section: Discussionmentioning

confidence: 99%

“…In particular, special positioning maneuvers such as head torsion [4], anterior neck skin traction [5], or the Killian position and its modified variants [6] have been described. Other procedures, some of which are also used in combination with the aforementioned maneuvers, attempt to dilate the anatomical structures of the hypopharynx with gas.…”

Section: Introductionmentioning

confidence: 99%

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Enhancing Visibility of the Hypopharyngeal-Esophageal Region by Introduction of a Physiological Eructation Maneuver

et al. 2019

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Background: In routine medical examination, the hypopharyngeal-esophageal area (HER) is difficult to assess due to its position and anatomical complexity. The purpose of this study was to evaluate the feasibility of a volitional eructation maneuver during transnasal flexible laryngoscopy and its influence on the visibility of the HER. Methods: Twenty healthy volunteers underwent flexible laryngoscopy. Once the larynx was freely visible during laryngoscopy, the subjects were asked to trigger a “burp.” The volitional belching during the study was assisted by drinking a carbonated cold drink. The triggered relaxation of the upper esophageal sphincter along with the widening of the hypopharynx region was recorded and subsequently analyzed frame by frame. Results: Out of 20 volunteers, 16 (80%) were able to volitionally induce an eructation. Significant widening of the hypopharynx region up to the relaxant upper esophageal sphincter could be recorded. The structures were clearly visible in the offline analysis. In 13 (81%) of the 16 subjects who could induce an eructation, the upper esophageal sphincter was partially visible or free for full inspection. Conclusion: The eructation method as a simple physiological function can be used as a complementary method during flexible transnasal endoscopy to enhance visibility of the entire hypopharynx region as well as the upper esophageal sphincter.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Enhancing Visibility of the Hypopharyngeal-Esophageal Region by Introduction of a Physiological Eructation Maneuver

et al. 2019

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“…The patient was bent further forward from the original Killian position, as if bowing. This posture is the MK position . Fifthly, the patient was asked to phonate “e” in the MK position (MK‐normal‐Ph).…”

Section: Methodsmentioning

confidence: 99%

Evaluation of modified Killian's method: A technique to expose the hypopharyngeal space

et al. 2014

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“…For improved computed tomography visualization of the piriform sinus and retrocricoid area, Hillel and Schwartz described the trumpet maneuver designed to insufflate the pharynx . For laryngoscopy, multiple manipulations have been described for improved laryngopharyngeal exposure . Tsunoda et al described a head torsion method to visualize the laryngeal ventricle and inferior surface of the vocal fold .…”

Section: Introductionmentioning

confidence: 99%

“…In patients with an oblique larynx, this maneuver was also found to improve insertion of the endoscope without obstruction of the epiglottis. Additionally, combinations of anterior traction, head torsion, insufflation, Valsalva, and chin‐to‐chest positioning have all been utilized to optimize laryngopharyngeal visualization during flexible laryngoscopy …”

Section: Introductionmentioning

confidence: 99%

Office‐based laryngology: Technical and visual optimization by patient‐positioning maneuvers

et al. 2018

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Objective/Hypothesis To qualitatively and quantitatively assess the effect of discrete head postures/maneuvers during flexible laryngoscopy on visualization of specific anatomical structures within the laryngopharynx. Study Design Prospective, observational study. Methods Flexible laryngoscopy was performed on 18 sequential patients. Videos of the laryngopharynx were captured during the neutral head position and five discrete maneuvers: maximal sniffing, head extension, right turn, left turn, and chin down. Images were analyzed using ImageJ, and differences in the (normalized) anatomical areas of interest were examined with each maneuver (paired t test]. Covariates for surgeon, nostril, and gender were evaluated. Results There was a significantly increased (P = 0.009) area of view of the anterior space (petiole of epiglottis/anterior laryngeal vestibule) with head extension. Right head turn led to a significantly increased view of the left pyriform sinus (P = 0.00001), whereas left head turn yielded an increased view of the right pyriform sinus (P = 0.0001). The right and left vocal fold/ventricle were better visualized during right head turn (with the scope traversing the right nostril) and left head turn (with the scope traversing the left nostril), respectively. Chin‐down posture achieved a more distal view of the airway more frequently than the other maneuvers. Conclusion The anterior space (supraglottic larynx) may be best visualized and accessed with head extension. Right and left head turn improve visualization of the contralateral piriform sinus. Chin down provides improved airway visualization in a plurality of patients. Future studies examining maneuvers are warranted to create a catalog of validated techniques to optimize the efficacy of the office‐based proceduralist. Level of Evidence 2 Laryngoscope, 129:330–334, 2019

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A new technique to expose the hypopharyngeal space: The Modified Killian's method

Cited by 36 publications

References 5 publications

Enhancing Visibility of the Hypopharyngeal-Esophageal Region by Introduction of a Physiological Eructation Maneuver

Enhancing Visibility of the Hypopharyngeal-Esophageal Region by Introduction of a Physiological Eructation Maneuver

Evaluation of modified Killian's method: A technique to expose the hypopharyngeal space

Office‐based laryngology: Technical and visual optimization by patient‐positioning maneuvers

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