In cases of a difficult intubation where numerous intubation methods, including laryngoscopy, have failed, yet oral intubation is still necessary, the method of tube exchange after fiberoptic nasal intubation may be attempted. Fiberoptic nasal intubation allows intubation to be performed relatively easily when the laryngeal view grade is poor. We report a case in which our attempt at oral intubation for total maxillectomy with laryngoscopy and fiberoptic oral intubation had failed due to an unexpected difficult airway; subsequently, we successfully completed the surgery by performing fiberoptic nasal intubation to secure the airway, followed by using a tube exchanger to exchange to an oral endotracheal tube.
Humans ; Intubation ; Laryngoscopy ; Methods

BACKGROUND AND OBJECTIVES: Although suspension laryngoscopy is a very common procedure in the otolaryngoloical field and suspension force (Fs) is suspected to be related with the complications or laryngeal exposure, Fs has not been objectively measured yet. The objective of this study is to measure suspension force continuously during suspension laryngoscopy. SUBJECTS AND METHOD: Sixteen patients who had undergone laryngoscopic surgery were evaluated. The value measured with a load cell during the procedure was converted to Fs with calculation. The maximum force (Fsmax) and the mean force (Fsmean) were evaluated. The angle between the laryngoscope and the chest holder(angle alpha), and the angle between the chest holder and the horizontal plane (angle beta) were gauged. RESULTS: The mean values of Fsmax and Fsmean were 14.2 and 25.5 kgf, respectively. The mean values of angle alpha and angle beta were 124.0+/-4.3 degrees, and 19.0+/-2.6 degrees, respectively. CONCLUSION: The continuous measurement of the suspension force was executed successfully and quantitatively with a simple method.
Humans ; Laryngoscopes ; Laryngoscopy* ; Methods ; Thorax

OBJECTIVE: To compare the efficacy and safety of applications of GlideScope video laryngoscope (GSVL) and Macintosh direct laryngoscope (MDLS) during endotracheal intubation under general anesthesia of abdominal snoring surgeries. METHOD: Forty patients ranged from American Society of Anesthesiologists I to II scheduled for snoring surgery under general anesthesia with endotracheal intubation were randomly divided into GSVL group and MDLS group (20 cases in each group), After traditional induction, endotracheal intubation (ETT) performed by GSVL or MDLS. Glottic exposure, the time of endotracheal intubation(from mask ventilation ending to successful intubation), the times of tracheal intubation operation were recorded in both groups. The mean artery pressure(MAP), heart rate(HR) were monitored before induction (basic value T0), before tracheal intubation (T1), after tracheal intubation (T2), 1 min after tracheal intubation (T3), 3 mins after tracheal intubation (T4). RESULT: The glottic exposure of GSVL group is superior to that of MDLS group. There was no significant difference in the time of tracheal intubation between MDLS group (27 +/- 11)s and GSVL group (26 +/- 11)s (P < 0.05). Compared with T0, MAP of T1 was lower in two groups (P < 0.05), while HR were similar both in two groups (P > 0.05). MAP of T2 and T3 increased and HR became faster (P < 0.05). MAP of T4 declined, but HR still increased (P < 0.05). Between the two groups, there was no significant difference of MAP or HR (P > 0.05). CONCLUSION Compared with MDLS,the GSVL is of benefit to improve the glottic exposure in endotracheal intubation to the snoring patients,so as to improve the success rate of tracheal intubation. But there is no obvious advantages via GSVL in preventing hemodynamic reaction during tracheal intubation.
Adult ; Aged ; Anesthesia, General ; Female ; Humans ; Intubation, Intratracheal ; methods ; Laryngoscopy ; methods ; Male ; Middle Aged ; Snoring ; surgery

OBJECTIVE: To build up a simple and effective comprehensive system for predicting difficult laryngeal exposure under suspension laryngoscopy. METHOD: One hundred and twenty cases of laryngeal tubor were selected. Using Logistic regression method to analyse relative factors, including weight, height, BMI, neck girth, neck upward degree, upper-lower incisor teeth distance, thyroid-mentum distance, thyroid-sternum distance, Mallampati test, Yamamoto test and Upper lip bite test. Build data-base to construct a comprehensive system for predicting difficult laryngeal exposure under suspension laryngoscopy. RESULT: The relative factors of difficult laryngeal exposure were BMI, neck girth, upper-lower incisor teeth distance, neck upward degree, thyroid-mentum distance, Mallampati test and Yamamoto test (P < 0.05). To build up a comprehensive system for predicting difficult laryngeal exposure under suspension laryngoscopy. The predicting standards included the seven relative factors, each factor has 1 score, 2 score, 3 score. Higher score means more risk. Eight score was designed as minimum, under the premise,the sensibility, misdiagnosis rate, missed misdiagnosis rate, specificity of the experiment were 95.5%, 5.3%, 4.5%, 94.7%. CONCLUSION The comprehesive system is an effective method for predicting difficult intubation. It can help to identify difficult cases according to the results of this predicting system.
Anthropometry ; Chin ; Humans ; Intubation, Intratracheal ; methods ; Laryngoscopy ; methods ; Larynx ; Lip ; Neck ; Thyroid Gland

Objective:To investigate the clinical manifestations and the effect of peroral endoscopic-assisted laryngeal microsurgery for children with laryngeal neurofibroma, and to provide clinical reference for the diagnosis and treatment of this disease. Methods:The clinical data of 4 children with laryngeal tumors admitted to the Department of Otorhinolaryngology, Children's Hospital of Chongqing Medical University from January 2021 to June 2023 were retrospectively analyzed. Laryngeal tumors were removed by peroral endoscopic-assisted laryngeal microsurgery. One case underwent tracheotomy at the same time, and one case was simultaneously performed with laryngeal T tube placement and tracheotomy. Results:Surgical resection is the best treatment for laryngeal neurofibroma, and laryngeal microsurgery should be actively used for patients with surgical indications.This surgical method has the advantages of good efficacy, minimal invasion, aesthetics and preservation of laryngeal function, which not only ensures safety, but also improves the quality of life after surgery, and has the value of development and promotion.
Child ; Humans ; Laryngeal Neoplasms/pathology* ; Laryngoscopy/methods* ; Microsurgery/methods* ; Retrospective Studies ; Quality of Life ; Neurofibroma/diagnosis*

At present, there is no unified gold standard for the treatment of laryngeal clefts. Type Ⅰ laryngeal clefts with mild symptoms can be treated conservatively, such as thick diet feeding and using proton pump inhibitor to control reflux, while Ⅱ-Ⅳ laryngeal clefts mostly requires surgical intervention.There are many different surgical methods for the treatment of laryngeal clefts, including injection laryngoplasty, endoscopic surgical repair of laryngeal clefts and open laryngoplasty through anterior cervical approach. How to choose a more suitable surgical plan for children is a problem worth discussing. This article will review the literature on the surgical treatment of laryngeal clefts both domestically and internationally, and summarize the current situation and challenges of surgical treatment of laryngeal clefts.
Child ; Humans ; Congenital Abnormalities/surgery* ; Endoscopy ; Laryngoplasty/methods* ; Laryngoscopy/methods* ; Larynx/surgery*

OBJECTIVETo investigate the efficacy of suspension laryngoscopic surgery for benign laryngotracheal stenosis (LTS).

METHODSThirty-two patients (aged from 5 to 70 years with a median of 36 years) with benign LTS were studied retrospectively who were treated by suspension laryngoscopic surgery with or without assistance of CO₂ Laser for LTS. Stents were placed in 17 cases. Among 32 patients, 13 cases were with LST in Cotton I, 8 cases in Cotton II, and 11 cases in Cotton III; 23 were with single level narrow, and 9 cases with multi-level narrow; the average narrow length was 1.3 cm and the average diameter at maximum stenosis was 0.5 cm; and 19 cases underwent tracheostomy before surgery.

RESULTSFollow-up period ranged from 1 to 18 years with median time of 10 years. Twenty-six patients (81.2%) were successfully decannulated with good airway patency and effective phonation. Six cases failed and 1 case of them was changed to open surgery. Among 17 cases with stent placement, 4 cases were applied additionally with T tube (effective rate of 50.0%), 1 case with laryngeal keel, 12 cases with stents alone (effective rate of 66.7%). Stent-related complications occurred in 2 cases. Patients with cotton I-II had a successful rate of 100% (21/21), while patients with Cotton III showed poor effectiveness (5/11), with a statistical significant difference between two groups (χ² = 14.098, P = 0.001). The patients with single level LTS were successfully treated by suspension laryngoscopic surgery with 100% successful rate (23/23), while the patients with multi-level LTS showed poor effectiveness (3/9), with a statistical significant difference between two groups (χ² = 18.872, P = 0.000) .

CONCLUSIONSSuspension laryngoscopic microsurgery can treat single level LTS with good results and also can be used as a pre-surgery in treatment of multi-level LTS with the virtue of minimal trauma and short recovery time. Application of stents can be helpful for suspension laryngoscope surgery for LST.

Constriction, Pathologic ; Humans ; Laryngoscopy ; methods ; Lasers, Gas ; Microsurgery ; Retrospective Studies ; Stents ; Tracheal Stenosis ; surgery ; Tracheostomy

OBJECTIVE: To compare the therapeutic effect between endoscopic thyroidectomy and open thyroidectomy. METHOD: One hundred and nine patients were randomly divided into two groups. The first group with 52 patients were carried out endoscopic thyroidectomy; and the second group with 57 patients was carried out open thyroidectomy. Clinical features including operation time, operative blood loss, hospitalization and complications were compared between the two groups. RESULT: The average operative time was (105.1 +/- 30.2) min in endoscopic group and (145.3 +/- 27.4) min in open group (P<0.01); the mean operative blood loss was (7.5 +/- 4.2) ml in endoscopic group and (48.6 +/- 18.6) ml in open group (P<0.01); the average hospitalization after operation was (4.1 +/- 1.4) days and (8.0 +/- 1.9) days (P<0.01), the complication rate was 5.8% in endoscopic group and 8.8% in open group (P<0.01). CONCLUSION Compared to the traditional open surgery, endoscopic thyroidectomy is safe and effective,with advantages in terms of the aesthetic property,the amount of bleeding and the postoperative complications.
Adult ; Female ; Humans ; Laryngoscopy ; Male ; Middle Aged ; Thyroid Neoplasms ; surgery ; Thyroidectomy ; methods ; Treatment Outcome ; Young Adult

Objective To compare the impacts of different nostril on nasotracheal intubation with video laryngoscopy.Methods Totally 120 ASA grade I maxillofacial surgery patients were equally randomized into two groups:group A(left nostril)and group B(right nostril).After rapid induction of anesthesia,the nasal intubation was completed by Tosight video laryngoscope,and the success rate of the first attempt of the tube passing through the nasal cavity was recorded and compared between these two groups.In addition,time of tube through nasal cavity,time of glottis exposure,total intubation time,intubation success rate,and nasal bleeding were recorded.Results The success rate of the first attempt of tube passing through the nasal cavity was not significantly different between groups A and B(84.7% . 81.7%;=0.202,=0.653).The time of tube passing through nasal cavity [(7.3±4.6)s .(7.5±4.1)s;=-0.223,=0.824] and the time of glottic exposure [(6.6±1.4)s .(6.7±1.4)s;=-0.348,=0.728] had no significant differences between two groups.The success rates of first intubation attempt were 100% in both groups.The total intubation time was(35.1±9.2)s in group A and(34.0±7.8)s in group B(=0.663,=0.509).Intubation-related epistaxis was found in 16 cases(27.1%)in group A and in 17 cases(28.3%)in group B( =0.022,=0.882).Conclusion Different nasal approaches have no effect on nasal intubation.
Glottis ; Humans ; Intubation, Intratracheal ; methods ; Laryngoscopes ; Laryngoscopy ; Nasal Cavity ; Oral Surgical Procedures

OBJECTIVE: To investigate the effect of laryngoscopic surgery combined with nasal endoscopic system for the treatment of vocal cords benign lesions. METHOD: Fifty-two patients admitted to our department with vocal cords benign lesions (including vocal polyps, vocal nodules, vocal cord cyst) underwent laryngoscopic surgery combined with nasal endoscopic system. RESULT: All patients were treated successfully once and for all without any significant postoperative complication. CONCLUSION The laryngoscopic surgery combined with nasal endoscopic system is a safe, minimally invasive and simple method for the treatment of benign lesions of vocal cords.
Adult ; Aged ; Female ; Humans ; Laryngeal Diseases ; surgery ; Laryngoscopy ; methods ; Male ; Middle Aged ; Vocal Cords ; pathology