Head torsion technique for detailed observation of larynx and hypopharynx

Tsunoda, Atsunobu; Ishihara, Akiko; Kishimoto, Seiji; Tsunoda, Reiko; Tsunoda, Koichi

doi:10.1017/s0022215106005251

Cited by 14 publications

(10 citation statements)

References 2 publications

(2 reference statements)

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“…Previously, Tsunoda et al reported improved visualization of a lateralized laryngeal lesion with a contralateral nasal insertion of the laryngoscope. 11 With the addition of a head turn maneuver, however, our data suggests greater ipsilateral vocal fold and ventricular exposure with an ipsilateral head turn and the scope passed through the same-sided nasal passage in comparison to the contralateral nare. This finding, although intriguing, did not reach statistical significance, likely due to insufficient sample size.…”

Section: Discussionmentioning

confidence: 67%

“…8-10 Tsunoda et al described a head torsion method to visualize the laryngeal ventricle and inferior surface of the vocal fold. 11 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: 95%

“…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 . In patients with an oblique larynx, this maneuver was also found to improve insertion of the endoscope without obstruction of the epiglottis.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 67%

Section: Introductionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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“…In the ENT clinic, transnasal examination of patients in a sitting position has several advantages compared to transoral examination with patients in the lateral position [8,9]. Examination in a sitting position is more natural and comfortable for patients.…”

Section: Discussionmentioning

confidence: 99%

High-Resolution ENT Video Endoscope with Superior Image Quality Equivalent to that of Gastric Video Endoscopes

Tsunoda

Tsunoda²,

Sumi³

et al. 2014

Otolaryngology

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“…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%

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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Head torsion technique for detailed observation of larynx and hypopharynx

Cited by 14 publications

References 2 publications

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

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

High-Resolution ENT Video Endoscope with Superior Image Quality Equivalent to that of Gastric Video Endoscopes

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

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