First Stage

Sources: A Manual Of Peroral Endoscopy And Laryngeal Surgery

The spatular end of the laryngoscope is introduced in

the right side of the patient's mouth, along the right side of the

anterior two-thirds of the tongue. It was the German method to

introduce the laryngoscope over the dorsum of the tongue but in order

to elevate this sometimes powerful muscular organ considerable force

may be required, which exercise of force may be entirely avoided by

crowding the tongue over to the left. When the posterior third stage

of the tongue is reached, the tip of the laryngoscope is directed

toward the midline and the dorsum of the tongue is elevated by a

lifting motion imparted to the laryngoscope. The epiglottis will then

be seen to project into the endoscopic field, as seen in Fig. 54.

[FIG. 54.--End of the first of direct laryngoscopy, recumbent adult

patient. The epiglottis is exposed by a lifting motion of the spatular

tip on the tongue anterior to the epiglottis.]