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Published on: December 1, 2023
Improved airway visualization during direct laryngoscopy using self-retaining laryngeal retractors: a quantitative
Beck Longstreet1, Prabhat K Bhama, Andrew F Inglis
1University of Washington School of Medicine, Seattle, Washington, USA.
Insights
The Lindholm laryngeal distending forceps significantly improve visualization during pediatric direct laryngoscopy. These forceps enhance glottic opening and vocal cord visibility, aiding in diagnosis and treatment.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Medical Device Technology
Background:
- Direct laryngoscopy is crucial for pediatric airway examination.
- Limited visualization can hinder diagnosis and treatment of laryngeal pathologies.
- The Lindholm laryngeal distending forceps are designed to improve exposure during this procedure.
Purpose of the Study:
- To quantify the improvement in laryngeal visualization provided by the Lindholm laryngeal distending forceps.
- To assess the impact of the forceps on glottic opening and vocal cord exposure in pediatric patients.
Main Methods:
- A case series with chart review was conducted at a pediatric hospital.
- Intraoperative endoscopic photos were analyzed before and after using the Lindholm forceps.
- Imaging software quantified changes in glottic opening, vocal cord area, and anterior commissure angle.
Main Results:
- The Lindholm forceps increased glottic opening by a mean of 359% and visualized true vocal cord area by 337%.
- The anterior commissure angle increased significantly, from 24.9° to 71.5° (a mean increase of 46.6°).
- All observed improvements in visualization were statistically significant (P < .01).
Conclusions:
- The Lindholm laryngeal distending forceps substantially enhance visualization of the vocal folds, anterior commissure, and subglottic region.
- Improved exposure facilitates better diagnosis and treatment of laryngeal pathologies during pediatric direct laryngoscopy.
- These findings support the utility of the Lindholm forceps in pediatric airway management.
Objective:
To measure the degree to which the Lindholm laryngeal distending forceps improve visualization during direct laryngoscopy in selected pediatric patients.
Study Design:
Case series with chart review.
Setting:
Pediatric hospital.
Subjects And Methods:
Subjects included children undergoing direct laryngoscopy using the Lindholm laryngeal distending forceps. Intraoperative endoscopic photos with and without false cord retraction via the Lindholm laryngeal distending forceps were obtained from the Seattle Children's Hospital airway endoscopy photo library. Analysis was performed using imaging software. Comparisons of visible vocal cord and glottic opening areas as well as anterior commissure angles with and without the Lindholm laryngeal distending forceps were performed with a paired and unpaired Student t test.
Results:
The use of the Lindholm laryngeal distending forceps increased the glottic opening by a mean of 359% (95% confidence interval [CI], 255%-463%) and increased visualized true vocal cord area by 337% (197%-477%). Angle at the anterior commissure increased from a mean of 24.9° to a mean of 71.5°, resulting in a net mean angle increase of 46.6° (95% CI, 40.2°-52.9°). All measured changes were statistically significant with P values <.01.
Conclusions:
When placed at the level of the false vocal folds, Lindholm laryngeal distending forceps will, at least in certain cases, greatly increase the visible area of the superior surface of the vocal folds, the anterior commissure, and, by increasing the glottic opening, the subglottic region. This improved visualization may enhance the surgeon's ability to diagnose and treat pathologies in these anatomic regions during direct laryngoscopy.
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