Office-Based Laryngoscopy Good Practicing Laryngoscopy Part2

Transoral Rigid Laryngoscopy – Handling the Endoscope

Left Hand: Holding the Patient’s Tongue

• We recommend the use of gloves when holding the patient’s tongue.

• Ask the patient to stick out their tongue. Grip the tongue tip by placing your thumb on the superior surface and the middle finger underneath.

• Be careful not to hurt the patient by pressing the tongue against the lower incisors or by pulling too much.

• Keep finger contact with the patient’s cheek or chin using either your left index or little finger in order to control the position of the patient’s head.

• There are various ways to use the left index finger.

• Use a cotton gauze square rather than paper as it has better gripping properties.

Ask the patient to stick out their tongue

Start by wrapping the tip of the tongue with a gauze square.

The left index finger can be placed and used in a variety of ways. Here it is under the tongue and holding the tongue.

Here the left index finger is touching the patient’s cheek, thus enabling some control of the patient’s head position. The thumb is on the upper side of the tongue, with the middle finger underneath.

Sometimes it is easier when the patient holds the own tongue, especially during indirect phonosurgery.

• There are various ways in which the left hand can be used while inserting the endoscope into the oral cavity.

• You can control the position of the patient’s head (A, B, C) and their mouth opening (A, B) with your left index finger.

• You can also control the position of the patient’s head by using your little finger to lift the patient’s chin (D, F).

• Additionally, you can stabilize the position of the endoscope with your left index finger (D, E, F).

A) Variation: Left index finger lifts the upper lip

B) Variation: Left index finger beneath the upper teeth

C) Variation: Left index finger above the upper lip, directing the head’s position

D) Variation: Left index finger above upper lip, directing head position, supported by the little finger under the patient’s chin. With this 3-point-grip you can “move” the head into any required position.

E) Variation: The endoscope rests on the left index finger

F) Variation: The endoscope rests on the left index finger, the little finger is under the chin directing head position.

Right Hand: Inserting the Endoscope

• The position of the right hand varies, depending on the different handgrips which can be used with the camera and endoscope.

• By rotating the endoscope sidewards during intraoral passage you can avoid touching the tongue base and consequently blurring the lens. Simply rotate the endoscope downwards when its tip is behind the uvula.

A, C): Endoral passage

B, D): Tip of endoscope in oropharynx. Rotation downwards completed.

C, D): Holding the endoscope from above, examiner standing.

The Examiner’s Head Position

• While entering the mouth, the position of the endoscope, the elevation of the velum, and the opening of the oropharynx are controlled by looking into the patient’s mouth.

• Ask the patient to breathe through the mouth.

• When the endoscope tip passes the uvula, i.e. the faucial pillars, the rest of the endoscopy is visualized on the monitor screen.

• Pay attention to the position of the monitor and the height of the chairs – you should be able to see both the patient’s mouth and the monitor with a minimal am ount of head turning.

A) Examiner sitting; endoscope tip in oral cavity

B) Examiner sitting; endoscope tip passes the uvula, examiner turns head to monitor

C) Same as (A), but now examiner standing. Check position of endoscope by looking directly in the mouth.

D) Same as (B), but now examiner standing. After the endoscope tip passes the uvula continue to control the endoscopy via monitor