Techniques

This chapter assumes familiarity and competence with the endoscopic techniques and instruments discussed herein, including facile use of the rigid bronchoscope.

Laryngoscopy

If it is to be performed concurrently with rigid bronchoscopy, laryngoscopy is done first, almost always under general anesthesia. Where laryngeal complexities are suspected or where it is possible that a laryn-geal surgical procedure will have to be done at the time of the examination, or later as an independent but preceding procedure, a consulting otolaryngologist should be present. Often, the consulting otolaryngolo-gist will have examined the patient previously, and already have performed an indirect or flexible laryngos-copy. We find the Holinger anterior commissure laryngoscope to be particularly useful for examining the glottis and subglottic larynx under anesthesia (Figure 5-1A). The Lewy suspension apparatus is frequently useful (Figure 5-1B). Anesthesia or ventilation may be easily maintained by intermittent placement of an endotracheal tube through the laryngoscope. Hopkins optical telescopes provide a clear, magnified view

figure 5-1 A, A Holinger anterior commissure laryngoscope, especially useful for direct visualization of the glottis and subglottic larynx. B, The Lewy suspension apparatus in use. The angle of the laryngoscope is fully adjustable.

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