Surgery Treatment

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Definition: Direct laryngoscopy is a direct visualization of the different parts of the larynx and hypopharynx.

    • Diagnostic:
      • When indirect laryngoscopy is not possible, e.g. in young children and infants for laryngeal lesions like stridor.
      • Vocal cord paralysis.
      • Extent of the growth in cases of carcinoma of the vocal cords and to take a biopsy.
      • As a part of panendoscopy in cases of unknown primary with cervical metastasis.
      • Excision of benign lesions of the larynx such as papilloma, vocal nodules or cyst.
      • Insertion of laryngeal stents.
      • Injection of teflon paste in the vocal cord in cases of vocal cord palsy.
      • Dilatation of subglottic stenosis.
    • Procedure is done under general anesthesia.
    • The patient is in Boyce position with flexion of the cervical spine and extension of the atlanto-occipital joint.
    • The laryngoscope is held in the right hand and inserted into the oval cavity till the epiglottis is visualized.
  • 4. The tip of the epiglottis is lifted with the laryngoscope.
  • 5. The larynx is then visualized.
Structure visualized:
    Following structures are examined serially:
    • Base of tongue.
    • Median and lateral glossoepiglottic fold.
    • 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.
    • Subglottic area.
    • Mobility of vocal cords is also observed.
  • Damage to lips, gums, or tongue.
  • Damage to the cervical spine.
  • Anesthetic complications.
  • Vasovagal stimulation due to manipulation of the larynx.
  • However, the above complications are greatly minimized in skilled hands and with good instrumentation setup.

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