ENT , Laryngoscopy

1. DIRECT LARYNGOSCOPY

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

3. INDICATIONS
DIAGNOSTIC
1. In infants and children and when symptomatology points to
larynx and/or hypopharynx, e.g. hoarseness, dyspnoea, stridor
and dysphagia.
2. 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.
3. 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. 1. Removal of benign lesions of Larynx
2. Removal of foreign bodies from Larynx and Hypopharynx
3. 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 require
d if procedure is for diagnostic purpose.

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

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

11. 6. If anterior commissure laryngoscope is being used, its tip can be
advanced further between the ventricular bands to examine the v
entricles and anterior commissure. It can be passed between the
vocal cords to examine the subglottic region.
7. Following structures are examined serially: Base of tongue, right
and left valleculae, epiglottis, (its tip, lingual and laryngeal surface
s), right and left pyriform sinuses, aryepiglottic folds, arytenoids, p
ostcricoid region, both false cords, anterior and posterior commis
sure, right and left ventricles, right and left vocal cords and subglo
ttic area. Mobility of vocal cords should also be observed.
A right-angled telescope can be used to see the undersurface of voc
al cords and the walls of the subglottis. After the procedure is comple
ted, laryngoscope is withdrawn and lips and teeth examined for any i
njury.

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 oedem
a and respiratory distress.
• Bleeding may occur from the operative site. Patient may
spit blood. Care should be taken to prevent aspiration.

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

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