direct LARYNGOSCOPY.pptx

ENT , Laryngoscopy

1. DIRECT LARYNGOSCOPY

2. INTRODUCTION It is the direct visualization of larynx and hypopharynx.

3. INDICATIONS DIAGNOSTIC In infants and children and when symptomatology points to larynx and/or hypopharynx, e.g. hoarseness, dyspnoea, stridor and dysphagia. When indirect laryngoscopy has not been successful, e.g. due to excessive gag reflex or overhanging epiglottis obscuring a part of complete view of the larynx. To find the extent of growth and take a biopsy.

4. 4. To examine hidden areas of: A) Hypopharynx: base of tongue, valleculae, lower part of pyriform fossa. B) Larynx: infrahyoid epiglottis, anterior commissure, ventricles, subglottic region INDICATIONS

5. A view by direct laryngoscopy of the glottic opening, which reveals the true vocal cords. The arytenoids (paired cuneiform and corniculate cartilages) are inferior and anterior to the position of the cords

6. Removal of benign lesions of Larynx Removal of foreign bodies from Larynx and Hypopharynx Dilatation of laryngeal strictures INDICATIONS THERAPEUTIC:

7. CONTRAINDICATIONS Diseases or injuries of cervical spine Moderate or marked respiratory obstruction unless the airway has been provided by tracheostomy. Recent coronary occlusion or cardiac decompensation.

8. ANAESTHESIA General anaesthesia is preferred though this procedure can be performed under local anaesthesia. In infants and young children, no anaesthesia may be required if procedure is for diagnostic purpose.

9. POSITION Patient lies supine. Head is elevated by 10–15 cm by placing a pillow under the occiput or by raising head flap of the operation table. Neck is flexed on thorax and the head extended on atlanto-occipital joint (barking-dog position)

10. A piece of gauze is placed on the upper teeth to protect them against trauma. Laryngoscope is lubricated with a little autoclaved liquid paraffin or jelly. Laryngoscope is held by the handle in the left hand. Right hand is used to retract the lips, guide the laryngoscope and to handle suction. And instruments. Laryngoscopee is introduced by one side of the tongue which is pushed to the opposite side till posterior third of tongue is reached. It is then moved to the midline and lifted forward to bring epiglottis in view. Laryngoscopee is now advanced behind the epiglottis and lifted forward without levering it on the upper teeth or jaw. This gives good view of the interior of the larynx. PROCEDURE

11. If anterior commissure laryngoscope is being used, its tip can be advanced further between the ventricular bands to examine the ventricles and anterior commissure. It can be passed between the vocal cords to examine the subglottic region. Following structures are examined serially: Base of tongue, right and left valleculae, epiglottis, (its tip, lingual and laryngeal surfaces), right and left pyriform sinuses, aryepiglottic folds, arytenoids, postcricoid region, both false cords, anterior and posterior commissure, right and left ventricles, right and left vocal cords and subglottic area. Mobility of vocal cords should also be observed. A right-angled telescope can be used to see the undersurface of vocal cords and the walls of the subglottis. After the procedure is completed, laryngoscope is withdrawn and lips and teeth examined for any injury.

12. POSTOPERATIVE CARE Patient is kept in coma position to prevent aspiration of blood or secretions. Patient’s respiration should be watched for any laryngeal spasm and cyanosis. Trauma to larynx, especially if repeated attempts at laryng-oscopy have been made. It may lead to laryngeal oedema and respiratory distress. Bleeding may occur from the operative site. Patient may spit blood. Care should be taken to prevent aspiration.

13. COMPLICATIONS Injury to lips and tongue if they are nipped between the teeth and the laryngoscope. Injury to teeth. They may get dislodged and fall into pharynx. Bleeding. Laryngeal oedema.

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