Direct Laryngoscopy Adult Patient

Sources: A Manual Of Peroral Endoscopy And Laryngeal Surgery

Before starting, every detail

in regard to instrumental equipment and operating room assistants,

(including an assistant to hold the arms and legs of the patient) must

be complete. Preparation of the patient and the technic of local

anesthesia have been discussed in their respective chapters. The

dorsally recumbent patient is draped with (not pinned in) a sterile

sheet. The head, covered by sterile towels, is elevated, and slight

extension is made at the occipitoatloid joint by the left hand of the

first assistant. The bite block placed on the assistant's right thumb

is inserted into the left angle of the patient's open mouth (see Fig.


The laryngoscope must always and invariably be held in the left hand,

and in such a manner that the greatest amount of traction is made at

the swell of the horizontal bar of the handle, rather than on the

vertical bar.

The right hand is then free for the manipulation of forceps, and the

insertion of the bronchoscope or other instrument. During

introduction, the fingers of the right hand retract the upper lip so

as to prevent its being pinched between the laryngoscope and the

teeth. The introduction of the direct laryngoscope and exposure of the

larynx is best described in two stages.

1. Exposure and identification of the epiglottis.

2. Elevation of the epiglottis and all the tissues attached to the

hyoid bone, so as to expose the larynx to direct view.