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Vocal fold exposure in phonosurgery

C W Vaughan1

  • 1Department of Otolaryngology, Boston University School of Medicine, Massachusetts.

Journal of Voice : Official Journal of the Voice Foundation
|June 1, 1993
PubMed
Summary
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Improving laryngeal exposure for difficult airways is achievable. Specific patient positioning, laryngoscope selection, and suspension techniques enhance visualization and reduce risks during laryngoscopy.

Area of Science:

  • Anesthesiology
  • Otolaryngology

Background:

  • Difficult laryngeal exposure poses challenges during airway management.
  • Standard laryngoscopy techniques may lead to complications like dental trauma or cervical spine injury.

Purpose of the Study:

  • To describe a refined technique for optimizing laryngeal exposure.
  • To minimize risks associated with difficult laryngoscopy.

Main Methods:

  • Utilizing the Boyce-Jackson "sniffing position" with further neck flexion.
  • Selecting an appropriate laryngoscope based on patient anatomy and glottic shape.
  • Employing a true suspension device for force application towards the larynx.
  • Placing the laryngoscope along the path of least resistance and allowing adequate time.

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Main Results:

  • Achieved near-perfect laryngeal exposure, visualizing true vocal folds from vocal process to anterior commissure.
  • Eliminated the need for external laryngeal pressure.
  • Kept the endotracheal tube positioned between the arytenoids, out of direct sight.
  • Prevented injury to teeth, gums, and the cervical spine.

Conclusions:

  • The described techniques significantly improve laryngeal exposure in challenging cases.
  • This method enhances safety by reducing the risk of airway instrumentation trauma.
  • Optimal laryngoscopy is achievable with careful attention to positioning, equipment, and technique.