Medical ArticlesBurns And Scalds
No matter what the nature and extent of the burn may be, the ...
Eyes Paralysis Of
The partial paralysis of the muscles of one eye produces doubl...
Stokes Adams Treatment
The treatment of true Stokes-Adams disease is unsuccessful. I...
In the original edition, good treacle was recommended as a lax...
Acute esophagitis calls for rest in bed, sterile liquid food...
Lumbago differs from both paralysis and cramp of the lower bac...
Chronic Myocarditis Fibrous
Chronic myocarditis may develop on an acute myocarditis, but ...
Tuberculosis Of The Tracheobronchial Tree
The bronchoscopic study of tuberculosis is very interesting,...
Treat croup, whether membranous or spasmodic, much the same a...
This is a contagious disease, consisting in an inflammation o...
Eyes Danger To Sight Of
Where inflammation has gone so far as to lead to suppuration, ...
Care Of The Nails
Importance of Clean Nails. On account of their constant use, ...
Exercise While Fasting
The issue of how much activity is called for on a fast is co...
Declining Limb A
See Limbs, Drawn up. ...
Inflammation Of The Lungs - Pneumonia
This disease is often connected with Pleurisy, and consists o...
There is a common and very popular error, namely, that of putt...
This peculiar burning and distressed feeling at the stomach d...
Deviation Of The Esophagus
Deviation of the esophagus may be marked in the presence of a...
Extent Of Electric Agency
When we have settled upon the position that the electricity o...
Ulcerative lesions in the larynx during typhoid fever are al...
Category: INTRODUCTION OF THE ESOPHAGOSCOPE
Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery
Passing the cricopharyngeus is the most difficult part of
esophagoscopy, especially if the patient is unanesthetized. Local
anesthesia helps little, if at all. The handle of the esophagoscope is
still pointing upward and consequently we are sure that the lip of the
esophagoscope is directed anteriorly. Force must not be used, but
steady firm pressure against the tonically contracted cricopharyngeus
is made, while at the same time the distal end of the esophagoscope is
lifted by the left thumb. At the first inspiration a lumen will
usually appear in the upper portion of the endoscopic field. The tip
of the esophagoscope enters this lumen and the slanted end slides over
the fold of the cricopharyngeus into the cervical esophagus. There is
usually from 1 to 3 cm. of this constricted lumen at the level of the
cricopharyngeus and the subjacent orbicular esophageal fibers.
 [FIG. 67.--Schematic illustration of the author's high-low
method of esophagoscopy. In the first and second stages the patient's
head fully extended is held high so as to bring it in line with the
thoracic esophagus, as shown above. The Rose position is shown by way
[FIG. 68.--Schematic illustration of the anatomic basis for difficulty
in introduction of the esophagoscope. The cricoid cartilage is pulled
backward against the cervical spine, by the cricopharyngeus, so
strongly that it is difficult to realize that the cricopharyngeus is
not inserted into the vertebral periosteum instead of into the median
[FIG. 69.--The upper illustration shows movements necessary for
passing the cricopharyngeus.
The lower illustration shows schematically the method of finding the
pyriform sinus in the author's method of esophagoscopy. The large
circle represents the cricoid cartilage. G, Glottic chink,
spasmodically closed; VB, ventricular band; A, right arytenoid
eminence; P, right pyriform sinus, through which the tube is passed in
the recumbent posture. The pyriform sinuses are the normal food
Next: Stage 3 Passing Through The Thoracic Esophagus
Previous: Stage I Entering The Right Pyriform Sinus