Objective: To design an instrument for steadying instrument handling during microlaryngeal surgery using an operating laryngoscope. Method: Our device design takes its cue (pun intended) from professional billiards players like our very own Efren "Bata" Reyes. The laryngeal tiririt (bridge or rake) draws inspiration from the billiards bridge (locally known as tiririt) used to extend the player's reach when the cue ball is too far to make an accurate shot. Setting: The laryngeal tiririt was used and tested by senior residents in microlaryngeal surgeries done in our institution. Result: The laryngeal tiririt greatly improved the accuracy required in laryngeal surgeries without adding up huge set up or expensive equipment. (Author)
LARYNGOSCOPES LARYNX

BACKGROUND: The Glidescope(R) videolaryngoscope is a new device for tracheal intubation that provides an improved view of the larynx. This study was performed to compare the Glidescope with the McGrath videolaryngoscope in terms of time to intubation (TTI) and number of attempts. METHODS: Patients were randomly allocated to one of two groups, Glidescope or McGrath group, by using computer-generated numbers. Tracheal intubation was attempted by an anesthesiologist with extensive experience using these two devices. The operator recorded ease of visualization of glottic structures based on the classification described by Cormack and Lehane. Number of failures, number of attempts and their duration, total intubation time, and events during the whole procedure were recorded. The duration of one attempt was defined as the time elapsed between picking up the endotracheal tube and verification of tracheal intubation with visualization of three expiratory carbon dioxide waveforms. TTI was defined as the sum of the duration of all intubation attempts (as many as three), excluding preoxygenation procedures. RESULTS: TTI was significantly shorter for the Glidescope(R) compared to the McGrath(R) laryngoscope (40.5 vs. 53.3 s, respectively, P < 0.05). However, glottic views obtained at intubation were similar between the two groups. Number of intubation attempts was not significantly different between the two groups (1.03 +/- 0.19 vs 1.10 +/- 0.32, respectively) (mean +/- SD). CONCLUSIONS: Study results demonstrated that the Glidescope reduced total intubation time in comparison with the McGrath, in terms of TTI in patients with normal airways.
Carbon Dioxide ; Humans ; Intubation ; Laryngoscopes ; Larynx

Vocal cord polyps are generally removed using a direct laryngoscope and surgical microscope. In some case of laryngeal microsurgery, laryngeal exposure with surgical microscope is difficult because of severalfactors. We experienced a case of vocal polyp with difficult laryngeal exposure in a 56 year old male patient. The vocal cord polyp was removed successfully through endoscopic approach.
Endoscopy ; Humans ; Laryngoscopes ; Larynx ; Male ; Microsurgery ; Polyps* ; Vocal Cords*

We report here the successful use of the Airtraq(R) optical laryngoscope (AOL) as a rescue device following failed awake flexible fiberoptic nasotracheal intubation of a patient with severe mandibular microsomia. We attempted awake fiberoptic nasotracheal intubation following topical anesthesia with 4% lidocaine spray three times to induce general anesthesia for distraction osteogenesis of mandibular bone. However, due to a shallow pharyngeal cavity and cranially displaced larynx, we failed to locate the larynx each time and were therefore not able to intubate the patient. Awake orotracheal intubation using the AOL allowed us to easily intubate the patient. Therefore, we recommend that the AOL be used as a rescue airway device for intubation of difficult airways.
Anesthesia ; Anesthesia, General ; Humans ; Intubation ; Laryngoscopes ; Larynx ; Lidocaine ; Osteogenesis, Distraction

PURPOSE: CT or MRT is performed in preoperative staging of laryngeal cancer. These methods are used in assessment of the deep tissues and cartilage of the larynx, but cannot compete with laryngoscopy in the evaluation of the laryngeal surface. The purpose of this study is to evaluate feasibilty and clinical value of the 3-D reconstruction of the mucosal surface in laryngeal cancer. METHODS AND MATERIALS: Twenty two patients with laryngeal cancer proved by means of surgical.exploration (pathologic) or clinical examinations including laryngoscope, imaging studies and biopsy underwent preoperative staging with computed tomography(G-P);and three dimensional(3D) CT reconstruction. The TNM classification of the American Joint Committee on Cancer was used to compare the imaging findings with pathologic or clinical staging. RESULTS: When the extension of primary tumor(T staging) was evaluated, the findings at only transaxial CT and those at pathologic or clinical examination were concordant in 8 of 14 cases(57.1%) of supraglottic tumor, and 3 of 6 cases(50%) of glottic tumor. The overall accuracy of CT with additional 3D-reconstruction was 85.7% for assessment of supraglottic tumor, and 66.6% for glottic tumor. CONCLUSION: 3D CT reconstruction after transaxial CT may improve outcome in preoperative staging of laryngeal cancer and has a potential value in guiding management decisions.
Biopsy ; Cartilage ; Classification ; Humans ; Joints ; Laryngeal Neoplasms* ; Laryngoscopes ; Laryngoscopy ; Larynx

CT of the laynx represents a major advance in laryngology, Even in severe injury the larynx can be examinedeasily and conveniently by CT at the same times the brain and facial structures without moving the patient, whoneed only lie down and breathe quietly during the study. CT permitted a much more detailed appraisal of layrngealdysfunction in patients with blunt laryngeal trauma (3 cases) and strangulation injury (2 cases). CT of the larynxundoubtedly played a determinant role in patient management. CT was helpful in evaluating the laryngeal cartilagesand deep spaces of the larynx wthich was difficult to examine by the laryngoscope. Follow-up CT made it possibleto evaluate the postoperative results.
Brain ; Follow-Up Studies ; Humans ; Laryngoscopes ; Larynx ; Otolaryngology

This 17 year-old male patient had an experience of a difficult intubation problem on miniplate removal operation after orthognathic surgery, but he didn't have the same problem on a previous orthognathic surgery 1 year before. He suffers from mental retardation and speaking disability due to congenital brain damage. I think difficult exposure of the larynx was caused by the imbalance of neck muscle force and jaw instability, as result from surgery. The preoperative airway evaluation is very important because findings may dictate choice of intubation technique. A flexible fiberoptic laryngoscope may be the most useful aid to awake intubation in the patient with a known difficult airway.
Adolescent ; Brain ; Humans ; Intellectual Disability ; Intubation* ; Jaw ; Laryngoscopes ; Larynx ; Male ; Neck Muscles ; Orthognathic Surgery

BACKGROUND: The larynx is longitudinally stretched and anteriorly displaced by inducing the general anesthesia and muscle paralysis, thus the laryngoscopic visualization might become difficult during direct laryngoscopy. The study was designed to assess the efficacy of the "laryngeal lift" maneuver in improving the laryngoscopic visualization to facilitate tracheal intubation. METHODS: Following the induction of general anesthesia and muscle paralysis, the laryngoscopic views of 287 patients were evaluated while the laryngeal lift by which the cricoid cartilage was displaced 0.5 cm posteriorly and 1.0~1.5 cm cephaladly were performed. One hundred and three patients with grade 2-4 laryngoscopic veiw were analysed. The laryngoscopic view which was described by Cormack and Lehane was classified from grade 1 to grade 4. The postoperative complications such as dysphasia and/or dyspnea were also observed. RESULTS: Seventy four patients of 81 patients with the laryngoscopic view of grade 2 were improved by one grade. Twenty one patients of 22 patients with the laryngoscopic view of grade 3 were improved by more than one grade. However, the laryngoscopic views of eight patients out of 103 patients were not improved. The tracheal intubation was successful in all patients. The overall, grade 2 and grade 3 improvement rate of laryngoscopic view was 92.2%, 91.4% and 95.5% respectively. The improvement rate by one grade and two grade was 89.3% and 2.9% respectively. CONCLUSIONS: The laryngeal lift had the high improvement rates of laryngoscopic view without any complications. Thus it is concluded that the laryngeal lift is a useful maneuver for improving laryngoscopic view during direct laryngoscopy with curved blade of laryngoscope.
Anesthesia, General ; Aphasia ; Cricoid Cartilage ; Dyspnea ; Humans ; Intubation ; Intubation, Intratracheal* ; Laryngoscopes ; Laryngoscopy ; Larynx ; Paralysis ; Postoperative Complications

When anesthesiologists encounter conditions in which intubation is not possible using a conventional direct laryngoscope, they can consider using other available techniques and devices such as fiber optic bronchoscope (FOB)-guided intubation, a laryngeal mask airway (LMA), intubating LMA (ILMA), a light wand, and the Combitube. FOB-guided intubation is frequently utilized in predicted difficult airway cases and is generally performed when the patient is awake to enable easier access to the trachea. An LMA can be introduced to ventilate the patient with relative ease, while an ILMA can be used for definite endotracheal intubation. However, occasionally, an endotracheal tube (ETT) cannot pass through the larynx, despite successful introduction of a FOB into the trachea and placement of an ILMA by the anesthesiologist. Therefore, we initially introduced an ILMA for emergent ventilation, followed by successful insertion of an ETT under FOB guidance. In this report, we describe three cases of difficult intubation using a FOB and ILMA combination approach.
Bronchoscopes* ; Humans ; Intubation* ; Intubation, Intratracheal ; Laryngeal Masks* ; Laryngoscopes ; Larynx ; Nerve Fibers, Myelinated* ; Trachea ; Ventilation

When anesthesiologists encounter conditions in which intubation is not possible using a conventional direct laryngoscope, they can consider using other available techniques and devices such as fiber optic bronchoscope (FOB)-guided intubation, a laryngeal mask airway (LMA), intubating LMA (ILMA), a light wand, and the Combitube. FOB-guided intubation is frequently utilized in predicted difficult airway cases and is generally performed when the patient is awake to enable easier access to the trachea. An LMA can be introduced to ventilate the patient with relative ease, while an ILMA can be used for definite endotracheal intubation. However, occasionally, an endotracheal tube (ETT) cannot pass through the larynx, despite successful introduction of a FOB into the trachea and placement of an ILMA by the anesthesiologist. Therefore, we initially introduced an ILMA for emergent ventilation, followed by successful insertion of an ETT under FOB guidance. In this report, we describe three cases of difficult intubation using a FOB and ILMA combination approach.
Bronchoscopes* ; Humans ; Intubation* ; Intubation, Intratracheal ; Laryngeal Masks* ; Laryngoscopes ; Larynx ; Nerve Fibers, Myelinated* ; Trachea ; Ventilation