Optimal Position for Transnasal Flexible Laryngoscopy

Taşlı, Hamdi; Bırkent, Hakan; Karakoç, Ömer; Gökgöz, Mert Cemal

doi:10.1016/j.jvoice.2018.11.006

Cited by 6 publications

(8 citation statements)

References 13 publications

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“…Office-based flexible transnasal laryngoscopy is a common routine procedure since many years. The development of new technical equipment such as flexible high-definition endoscopes allows for very precise examination [1][2][3][4][5][6][7][8][9]. The basic principle for getting optimal magnification in laryngoscopy is to decrease the distance of the lens to the target, i.e., the nearer one gets to the vocal fold, the more details one can see.…”

Section: Discussionmentioning

confidence: 99%

Dipping and rotating: two maneuvers to achieve maximum magnification during indirect transnasal laryngoscopy

Fleischer

Pflug

Heß³

2020

Eur Arch Otorhinolaryngol

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Background Since many years, office-based flexible transnasal laryngoscopy is a common routine procedure. The development of new technical equipment such as high-definition cameras and flexible tip-chip endoscopes nowadays allows for much more precise examination than a few years ago. In contrast to rigid laryngoscopy, it is possible to move the tip of the endoscope close to the vocal folds and to other structures of interest. Nevertheless, without professional handling of the equipment, one cannot benefit from the potential of the newest technology. Method Two easily performed and very helpful maneuvers in flexible endoscopy are described. The “dipping maneuver” enables a maximum magnification of the mucosal surfaces of the endolarynx as well as the examination of the subglottal region and the trachea by positioning the tip of the endoscope very close to the vocal folds or even in the upper trachea during long transnasal inspiration. During the “rotation laryngoscopy”, the tip of the endoscope is positioned in the posterior interarytenoid region by rotating the flexible endoscope by 180° and advancing it close to the glottis. This allows a close-up examination of the anterior commissure, the inferior aspect of the vocal folds and the inside of the Morgagni’s ventricle. Before performing transnasal flexible endoscopy, we routinely apply topical anesthesia sprayed intranasally. Conclusion The described techniques of flexible endoscopy are easily performed and allow a maximum magnification of the mucosal surfaces and otherwise not visible regions of the endolarynx.

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Section: Discussionmentioning

confidence: 99%

Dipping and rotating: two maneuvers to achieve maximum magnification during indirect transnasal laryngoscopy

Fleischer

Pflug

Heß³

2020

Eur Arch Otorhinolaryngol

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“…Thus, the usage of flexible laryngoscopy in OPD setting and DL in theater setting with anesthesia is more reasonable. Flexible laryngoscopy is a simple, safe and cost effective procedure which can be performed with simple head extension, sniffing position or sitting position [18].…”

Section: Advantagesmentioning

confidence: 99%

Laryngeal Examination with Laryngeal Mirror and Laryngoscopy

Kanakarajan¹,

N.K²

2023

Updates on Laryngology

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The management of all laryngeal pathologies begin with a simple and traditional examination with laryngeal mirror. Even though the use of mirror is invaluable, the image is often distorted and misleading in seven different ways. Direct laryngoscopy is a sermon on relaxation and does not require any local or general anesthesia in both children and adults. The greatest advantage of direct laryngoscopy is the presence of oblique illumination. This chapter deals with the different angulations of laryngeal mirrors and its seven drawbacks in detail. This also provides a detailed explanation of direct laryngoscopy technique in children and adults with its axioms and clinical application.

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“…4,5 Two studies describe the use of a flexed or "chin-tuck" head position to improve visualization of the distal airway in the awake patient. 4,6 Lastly, the laryngeal distraction or "stooping" maneuver, or chin tuck with head turn, has been implemented to obtain views of the subglottis and proximal trachea without the need for topical anesthetic administration. 7 However, there are minimal data regarding the ideal position for visualization of these anatomic regions, particularly in awake patients in an in-office setting.…”

mentioning

confidence: 99%

“…Several studies have shown that simple forward head extension, or “sniffing” position, optimizes the view of the supraglottic and glottic structures 4,5 . Two studies describe the use of a flexed or “chin‐tuck” head position to improve visualization of the distal airway in the awake patient 4,6 . Lastly, the laryngeal distraction or “stooping” maneuver, or chin tuck with head turn, has been implemented to obtain views of the subglottis and proximal trachea without the need for topical anesthetic administration 7 .…”

mentioning

confidence: 99%

“…Maneuvers aimed to enhance visualization of the aerodigestive tract in the awake patient during flexible laryngoscopy have been developed as more sophisticated technologies have allowed. Several studies have shown that simple forward head extension, or “sniffing” position, optimizes the view of the supraglottic and glottic structures 4,5 . Two studies describe the use of a flexed or “chin‐tuck” head position to improve visualization of the distal airway in the awake patient 4,6 .…”

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confidence: 99%

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Optimization of Subglottic View During Flexible Laryngoscopy With Patient Positioning

Highland

Torrecillas

Redding

et al. 2023

Otolaryngol.--head neck surg.

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ObjectiveDetermine the ideal head position to optimize visualization of the subglottis using flexible laryngoscopy.Study DesignProspective cohort study.SettingOutpatient multidisciplinary airway clinic at a tertiary care center.MethodsPatients presenting to a multidisciplinary airway clinic undergoing nasoendoscopic airway examination were enrolled. Three head positions were utilized to examine the subglottis during laryngoscopy: “sniffing,” chin tuck, and stooping positions. In‐office reviewers and blinded clinician participants evaluated views of the airway based on Cormack‐Lehane (CL) scale, airway grade (AG), and visual analog scale (VAS). Demographic data were obtained. Statistical analysis compared head positions and demographic data using Student's t test, analysis of variance, and Tukey's post hoc analysis.ResultsOne hundred patients participated. No statistical differences existed among in‐clinic or blinded reviewers for the CL score in any head position (p = .35, .5, respectively). For both AG and VAS, flexed and stooping positions were rated higher than the sniffing positions by both in‐clinic and blinded reviewers (p < .01 for all analyses), but there was no statistical difference between these two positions (p = .28, .18, respectively). There was an inverse correlation between age and scores for AG and VAS in the flexed position for both sets of reviewers (p = .02, <.01 respectively), and a higher body mass index was significantly associated with the need to perform tracheoscopy for full airway evaluation (p < .01).ConclusionBoth flexion and stoop postures can be implemented by an experienced endoscopist in awake, transnasal flexible laryngoscopy to enhance visualization of the subglottic airway.

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Optimal Position for Transnasal Flexible Laryngoscopy

Cited by 6 publications

References 13 publications

Dipping and rotating: two maneuvers to achieve maximum magnification during indirect transnasal laryngoscopy

Dipping and rotating: two maneuvers to achieve maximum magnification during indirect transnasal laryngoscopy

Laryngeal Examination with Laryngeal Mirror and Laryngoscopy

Optimization of Subglottic View During Flexible Laryngoscopy With Patient Positioning

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