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Direct Laryngoscopy In Children

Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery

The epiglottis in children is
usually strongly curled, often omega shaped, and is very elusive and
slippery. The larynx of a child is very freely movable in the neck
during respiration and deglutition, and has a strong tendency to
retreat downward during examination, and thus withdraw the epiglottis
after the arytenoids have been exposed. In following down with the
laryngoscope the speculum is prone to enter the hypopharynx. Lifting
in this location will expose the mouth of the esophagus and shut off
the larynx, and may cause respiratory arrest. Practice, however, will
soon develop a technic and ability to recognize the landmarks in state
of spasm, so that on exposing the approximated arytenoid eminences the
endoscopist will maintain his position and wait for the larynx to
open. The procedure should be done without any form of anesthesia for
the following reasons:
1. Anesthesia is unnecessary.
2. It is extremely dangerous in a dyspneic patient.
3. It is inadmissable in a patient with diphtheria.
4. If anesthesia is to be used, direct laryngoscopy will never reach
its full degree of usefulness, because anesthesia makes a major
procedure out of a minor one.
5. Cocain in children is dangerous, and its application more
annoying than the examination.

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