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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
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