Categories: DIRECT LARYNGOSCOPY
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
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.