Bronchial Dilators

Categories: INSTRUMENTARIUM
Sources: A Manual Of Peroral Endoscopy And Laryngeal Surgery

It is not uncommon to find a stricture of the

bronchus superjacent to a foreign body that has been in situ for a

period of months. In order to remove the foreign body, this stricture

must be dilated, and for this the bronchial dilator shown in Fig. 25

was devised. The channel in each blade allows the closed dilator to be

pushed down over the presenting point of such bodies as tacks, after

which the blades are opened an the stricture stretched. A small and a

large size are made. For enlarging the bronchial narrowing associated

with pulmonary abscess and sometimes found above a bronchiectatic or

foreign body cavity, the expanding dilator shown in Fig. 26 is perhaps

less apt to cause injury than ordinary forceps used in the same way.

The stretching is here produced by the spring of the blades of the

forceps and not by manual force. The closed blades are to be inserted

through the strictured area, opened, and then slowly withdrawn. For

cicatricial stenoses of the trachea the metallic bougies, Fig. 40, are

useful. For the larynx, those shown in Fig. 41 are needed.



[FIG. 34.--A, Mosher's laryngeal curette; B, author's flat blade

cautery electrode; C, pointed cautery electrode; D, laryngeal knife.

The electrodes are insulated with hard-rubber vulcanized onto the

conducting wires.]



[FIG. 35.--Retrograde esophageal bougies in graduated sizes devised by

Dr. Gabriel Tucker and the author for dilatation of cicatricial

esophageal stenosis. They are drawn upward by an endless swallowed

string, and are therefore only to be used in gastrostomized cases.]



[FIG. 36.--Author's bronchoscopic and esophagoscopic mechanical spoon,

made in 40, 50 and 60 cm. lengths.]



[FIG. 37.--Schema illustrating the author's method of endoscopic

closure of open safety pins lodged point upward The closer is passed

down under ocular control until the ring, R, is below the pin. The

ring is then erected to the position shown dotted at M, by moving the

handle, H, downward to L and locking it there with the latch, Z. The

fork, A, is then inserted and, engaging the pin at the spring loop, K,

the pin is pushed into the ring, thus closing the pin. Slight rotation

of the pin with the forceps may be necessary to get the point into the

keeper. The upper instrument is sometimes useful as a mechanical spoon

for removing large, smooth foreign bodies from the esophagus.]