Informational Site NetworkInformational Site Network
Privacy
 


Home


Medical Articles


Mother's Remedies


Household Tips


Medicine History


Forgotten Remedies


Search

Medical Articles

Infants' Sleep

See Children's Sleep. ...

Treatment Of Compression Stenoses Of The Trachea

If the thymus be at fault, rapid amelioration of symptoms fo...

Forceps

Delicacy of touch and manipulation are an absolute necessity...

Anomalies Of The Esophagus

Congenital esophagotracheal fistulae are the most frequent of...

Potato The

The proper cooking of this root is so important for health, ow...

Amusements

THE ability to be easily and heartily amused brings a wholeso...

Nervous Strain In Pain And Sickness

THERE is no way in which superfluous and dangerous te...

The Central Point Of The Circuit

The central point of the circuit--that point which divides be...

Cauliflower Growths

These begin like warts, and in the earlier stages poulticing a...

Vaccination Trouble

When a child is suffering after vaccination, we should have hi...

Cancer In Foot

We have noted one case in which "Cancerous Gangrene" in the fo...

Pleuroscopy

Foreign bodies in the pleural cavity should be immediately re...

Paralysis

This serious trouble in slighter forms affects one side of the...

To Mothers

MOST mothers know that it is better for the baby to p...

Indications For Esophagoscopy In Disease

Any persistent abnormal sensation or disturbance of function...

Clothing

Clothing should be light yet warm, and sufficiently free so as...

Nettle Rash

This is an eruption on the skin, often coming suddenly and goi...

Food And Mental Power

Unsuitable or ill-cooked food has a most serious effect on the...

Technic Of Specular Esophagoscopy

Recumbent patient. Boyce position. The larynx is to be expos...

Back Failures

Often a severe pain in the toe, foot, ankle, or lower leg has ...



Second Stage





Category: DIRECT LARYNGOSCOPY
Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery

The spatular end of the laryngoscope should now be
tipped back toward the posterior wall of the pharynx, passed posterior
to the epiglottis, and advanced about 1 cm. The larynx is now exposed
by a motion that is best described as a suspension of the head and all
the structures attached to the hyoid bone on the tip of the spatular
end of the laryngoscope (Fig. 55). Particular care must be taken at
this stage not to pry on the upper teeth; but rather to impart a
lifting motion with the tip of the speculum without depressing the
proximal tubular orifice. It is to be emphasized that while some
pressure is necessary in the lifting motion, great force should never
be used; the art is a gentle one. The first view is apt to find the
larynx in state of spasm, and affords an excellent demonstration of
the fact that the larynx can he completely closed without the aid of
the epiglottis. Usually little more is seen than the two rounded
arytenoid masses, and, anterior to them, the ventricular bands in more
or less close apposition hiding the cords (Fig. 56). With deep
general anesthesia or thorough local anesthesia the spasm may not be
present. By asking the patient to take a deep breath and maintain
steady breathing, or perhaps by requesting a phonatory effort, the
larynx will open widely and the cords be revealed. If the anterior
commissure of the larynx is not readily seen, the lifting motion and
elevation of the head should be increased, and if there is still
difficulty in exposing the anterior commissure the assistant holding
the head should with the index finger externally on the neck depress
the thyroid cartilage. If by this technic the larynx fails to be

revealed the endoscopist should ask himself which of the following
rules he has violated.

[FIG. 55.--Schema illustrating the technic of direct laryngoscopy on
the recumbent patient. The motion is imparted to the tip of the
laryngoscope as if to lift the patient by his hyoid hone. The portion
of the table indicated by the dotted line may be dropped or not, but
the back of the head must never go lower than here shown, for direct
laryngoscopy; and it is better to have it at least 10 cm. above the
level of the table. The table may be used as a rest for the operator's
left elbow to take the weight of the head. (Note that in bronchoscopy
and esophagoscopy the head section of the table must be dropped, so as
to leave the head and neck of the patient out in the air, supported by
the second assistant.)]

[FIG. 56.--Endoscopic view at the end of the second stage of direct
laryngoscopy. Recumbent patient. Larynx exposed waiting for larynx to
relax its spasmodic contraction.]





Next: Rules For Direct Laryngoscopy

Previous: First Stage



Add to del.icio.us Add to Reddit Add to Digg Add to Del.icio.us Add to Google Add to Twitter Add to Stumble Upon
Add to Informational Site Network
Report
Privacy
SHAREADD TO EBOOK


Viewed 859