Difficult direct laryngoscopy

Abstract

This article reviews some of the problems involved in direct laryngoscopy. It suggests adequate preparation and evaluation of the patient to avoid complications. An evaluation of laryngospasm is given. Solutions of the problems are suggested using gear power assistance and adequate drugs for relaxation. The importance of correct positioning of the patient is emphasized and illustrated. This summarizes clinical judgment and successful evaluation of the difficult mechanical problems in the exposure of the vocal cords.

Angled Endoscopic Laryngeal Surgery: A New Technique for Diagnosis, Surgery, and CO2 Laser Application

“…13 Situations in which it is difficult to obtain an adequate, sustained view of the laryngeal structures make microsurgery difficult or even impossible. 14 Conditions related to difficulties in direct laryngoscopy have been enumerated by Lewy and Brusca 15 as follows: 1) long incisor teeth, 2) short lower jaw, 3) short neck, 4) marked obesity, 5) cervical arthritis, and 6) prior surgery of the cervical spine. Except in cases of spinal surgery, patients with the described problems may be submitted for the angled technique because this new procedure allows placement of the instruments along an anatomically positioned larynx.…”

Suspension Microlaryngoscopy in the Boyce Position with a New Suspension Gallows

“…Position the horizontal cross bar of the gallows slightly anterior and caudal to the larynx and perpendicular to the handle of the laryngoscope. 5. Suspend the extended laryngoscope handle on the cross bar of the gallows.…”

A new instrument to expose the human larynx

“…Besides variation in laryngoscope design and shape, direct line-of-sight exposure of the vocal folds presents difficulties [1][2][3][4] such as failure to adequately expose parts of the larynx, 5 injuries from laryngoscope insertion, 6 and the limited field of view imposed by the walls of the tube. 7 Anatomic factors 8 and clinical conditions 9 are the main factors responsible for the drawbacks of direct laryngoscopy. Consequently, viewing and manipulation of tissue may not be properly accomplished when the surgeon relies solely on direct-exposure techniques.…”