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PubMed1992

[The value of nuclear magnetic resonance tomography in tumor staging of laryngeal-/hypopharyngeal cancer].

Twenty-four patients with tumors of the larynx and hypopharynx were examined with magnetic resonance imaging (MRI) and laryngoscopy. The results of MRI and laryngoscopy were then correlated with the pathology reports. Diagnostic findings of 84% of the MRI studies correlated with the pathology report, while laryngoscopy provided exact classification in 79%. MRI tended to overestimate tumor size because edema or inflammatory reactions of surrounding tissues simulated tumors. However, normal mucosa also enhanced contrast medium, restricting the value of this technique. Laryngoscopy tended to underestimate tumor size, because deep extensions of tumor and cartilage involvement were difficult to detect. Nonetheless, the utility of MRI in obtaining axial, coronal and sagittal slices was found to facilitate the preoperative staging of tumor extensions.

Carcinoma, Squamous Cell↗
PubMed2005

[Incidence of inappropriate cases for training of emergency medical technicians in endotracheal intubation].

BACKGROUND: Before emergency medical technicians are licensed to perform prehospital endotracheal intubation, they must undergo training in the operating room setting. We investigated the incidence of cases of difficult intubation classified as Cormack & Lehane grade III or IV, because such cases are considered inappropriate for training emergency medical technicians. METHODS: We examined anesthesia records between March 2002 and April 2003, retrospectively. The survey included 585 adult surgical patients with ASA physical status I or II requiring general endotracheal anesthesia. RESULTS: Five anesthesiologists and three doctors from the surgical department performed laryngoscopy during this period. In initial laryngoscopy with a Macintosh blade, the view of larynx was grade I in 436, grade II in 98, grade III in 27 and grade IV in 24 patients. In 68 patients, application of cricoid pressure led to improvement of laryngoscopy grade. The use of McCoy blade was necessary for intubation in 16 patients. Out of 51 patients classified as difficult intubation grade III or IV, 35 were originally not expected to be difficult cases. CONCLUSIONS: Patients with grade I or II view of larynx with a Macintosh blade was only 91%. In order to prepare for unexpected case of difficult intubation, it is necessary to take various measures such as having instructors perform laryngoscopy.

Anesthesia, General↗
PubMed1990

[Influence of hypercapnia on circulatory response to endotracheal intubation].

Effects of CO2 on circulatory responses to laryngoscopy and endotracheal intubation were investigated in 16 patients under constant depth of enflurane anesthesia (1.2MAC) at different levels of CO2 (normocapnia, PETCO2: 40mmHg or hypercapnia, PETCO2: 60mmHg). Patients were randomly divided into two groups; normocapnia group (n = 8) and hypercapnia group (n = 8). Although there was no significant difference in blood pressure response to laryngoscopy and endotracheal intubation between normocapnic and hypercapnic groups, heart rate response was significantly attenuated in hypercapnic group and the latent period between the start of laryngoscopy and the onset of increase in heart rate was significantly longer in hypercapnic group. Our results suggest that hypercapnia exerts inhibitory influence on heart rate responses to laryngoscopy and endotracheal intubation.

Adult↗
PubMed1981

Effect of propranolol on circulatory responses to induction of diazepam-nitrous oxide anesthesia and to endotracheal intubation.

The present study evaluated the hemodynamic effects produced by the intravenous infusion of diazepam (0.5 mg/kg over 10 minutes) and the simultaneous inhalation of 50% nitrous oxide in oxygen administered to 19 patients with coronary artery disease who were receiving chronic propranolol therapy (106 +/- 67 mg/day). In addition, hemodynamic changes produced by direct laryngoscopy and intubation of the trachea were measured. Data during the induction of anesthesia were compared to measurements obtained in a previously reported group of similar patients anesthetized in the same manner but not receiving propranolol. In the present study, as in previously observed patients not receiving propranolol, induction of anesthesia with diazepam-nitrous oxide did not result in any significant change from awake measurements with respect to heart rate (HR), mean arterial pressure (MAP), or rate-pressure product (RPP). Cardiovascular responses were similar in patients with awake resting heart rates greater than 70 beats per minute (nine patients) and less than 70 beats pr minute (10 patients). This suggests that propranolol does not alter the benign hemodynamic effects produced by this type of induction of anesthesia. Laryngoscopy and tracheal intubation significantly (p less than 0.01) increased MAP at 1 minute and HR and RPP at 1 and 2 minutes after the start of laryngoscopy. These changes were transient, returning to control values within 3 minutes after intubation. Patients with awake resting HR less than 70 beats per minute had greater increases in HR and RPP at 1 minute than did patients with resting HR greater than 70 beats per minute (p less than 0.05). This suggests that propranolol even in doses adequate to produce significant slowing of HR in awake patients does not ensure protection against increases in HR and MAP associated with laryngoscopy and intubation of the trachea.

Blood Pressure↗
PubMedDate not supplied

Recognition of the difficult airway in normal Nigerian adults (a prospective study).

Difficulty with laryngoscopy and intubation is known to be the most frequent cause of anaesthetic related deaths. Awareness of the possibility of difficulty would enable the anaesthetist to be adequately prepared. 57 "normal" adult patients were examined pre-operatively and at laryngoscopy using the Mallampatti (1985) and the Cormack (1984) classification respectively. The result showed that none of the patients was in the IV Mallampatti nor IV Cormack groups. Four patients with class III Mallampatti features were seen, two of which were classified Cormack III at laryngoscopy. Intubation failed in these two patients. The majority of patients were classified as Mallampatti class I (68.42%) and Cormack grade I (63.16%). This in effect demonstrates that in most "normal" patients laryngoscopy and intubation should be fairly easy.

Adult↗
PubMed1997

[Perforation of the laryngeal mucosa caused by closed trauma: comparison of laryngoscopic and CT findings].

INTRODUCTION: Laryngeal mucosal perforation is a frequent event whose diagnosis is based on clinical, laryngoscopic and CT findings. MATERIAL AND METHODS: We reviewed retrospectively the data relative to 77 patients with blunt neck trauma examined October, 1991, to June, 1996. All patients were submitted to clinical examination first and then, to fiberoptic laryngoscopy and CT on the clinician's request. RESULTS: Nineteen patients with small skin tears and no signs and symptoms of laryngeal injury were immediately discharged while 37 patients were submitted to surgery: 17 to remove cerebral hematomas, 13 to stabilize cervical fractures and 7 because of hemodynamic instability. Twenty-one patients underwent laryngoscopy which showed laryngeal lesions in 12: wide mucosal disruption with fractures of the laryngeal skeleton and hematomas were observed, which needed immediate surgery with airway reconstruction in 7 cases; small mucosal tears and hematomas were seen and laryngeal CT examination was requested to establish the possibility of conservative management in 5 cases which are the subject of the present study. Laryngoscopic findings were: 1) laryngeal mucosal tear near the thyroid cartilage with quadrangular membrane edema, 2) thyroid mucosal tear with thyrohyoid muscle edema, 3) edema of the left false vocal cord, 4) edema of the oblique arytenoid muscle, 5) posterior cricothyroid muscle edema with bleeding near the cricoid ring. In cases 1, 2 and 3 CT showed gas bubbles in the paralaryngeal space, where laryngeal tear or edema were indicated at laryngoscopy. DISCUSSION: CT does show the "gas bubbles" in the paralaryngeal space when laryngoscopy cannot distinguish laryngeal mucosal perforation from tear. CONCLUSIONS: The routine use of CT in minor, laryngeal injuries in the emergency department is useful for the early diagnosis of laryngeal mucosal perforation.

Adolescent↗
PubMed1999

Intralesional cidofovir for recurrent respiratory papillomatosis in children.

OBJECTIVE: To assess the potential benefit of intralesional administration of cidofovir, an acyclic nucleoside phosphonate with activity against several DNA viruses, for treating severe respiratory papillomas in pediatric patients. DESIGN: Prospective case series. SETTING: Tertiary care children's hospitals. PATIENTS: Five pediatric patients with severe recurrent respiratory papillomatosis requiring laryngoscopy with carbon dioxide laser therapy more frequently than once a month to maintain airway patency. Each patient underwent between 12 and 33 laryngoscopies with laser treatment prior to being injected with cidofovir. INTERVENTION: Microsuspension laryngoscopy with intralesional injection of cidofovir (Vistide) in conjunction with mechanical debulking and carbon dioxide laser of papillomas. MAIN OUTCOME MEASURE: Papilloma stage at time of serial laryngoscopies. RESULTS: One patient was disease free and 3 patients demonstrated a dramatic response to adjuvant therapy with cidofovir at the 9-month follow-up visit after the last injection of cidofovir. One patient showed an improvement in papilloma stage that was possibly related to concurrent therapy with interferon. CONCLUSIONS: Intralesional injection of cidofovir seems to be of benefit in the treatment of severe respiratory papillomatosis in pediatric patients. Larger prospective studies with longer follow-up will be required before cidofovir can be considered an accepted means of managing this difficult disease.

Antiviral Agents↗
PubMed1997

Leeches in the larynx.

This is a report of two patients with leech inhalation. The first patient presented with severe attacks of inspiratory stridor, cyanosis and cough of five days duration. He had no fever. Indirect laryngoscopy revealed a black, smooth foreign body between the vocal folds. Lateral soft tissue X-ray of the neck revealed shadow involving the glottic and the subglottic areas of the larynx. Laryngoscopy under general anaesthesia showed a living leech. This was removed and the patient improved. The second patient presented with difficulty of breathing, dysphagia, and spitting of blood of two weeks duration. Indirect laryngoscopy revealed a brown foreign body in the larynx. Laryngoscopy under general anaesthesia showed a living leech. This was removed by forceps.

Adult↗
PubMed2000

The adult Bullard laryngoscope as an alternative to the Wis-Hipple 1(1/2) in paediatric patients.

This prospective, randomized study was undertaken to compare the adult Bullard laryngoscope (BL) with the Wis-Hipple laryngoscope (WhL) in paediatric patients with regards to laryngeal view and time to intubation, and whether its efficacy was related to age or weight. Fifty patients scheduled for general anaesthesia between the ages of 1 and 5 years were examined. Patients were randomized into two groups: one group had an initial laryngoscopy via the WhL and then had a laryngoscopy and intubation using the BL; the second group had an initial laryngoscopy with the BL and then had a laryngoscopy and intubation using the WhL. The laryngeal view, attempts at intubation, time to intubation and the reason for any difficulty with intubation were recorded. Correlation was then sought relating attempts and time to intubation with age, and weight. Mean time to intubation was 20 +/- 6 s in the WhL group and 26 +/- 9 s in the BL group (P < 0.02). The majority of the patients had similar laryngeal views in both groups; three patients had a superior view with the BL. Failed intubations occurred in two BL patients; the tracheas were both intubated with the WhL. In one patient, intubation was not possible with the WhL but it was successful with the BL. Multiple passes of the tube off the BL most frequently occurred because of right aryepiglottic fold contact or anterior vocal cord contact. The latter appears to be more problematic when the adult BL is used in the paediatric population. No relationship was found between the time to intubation and age or weight. In an occasional child, the BL provides a superior laryngeal view and provides a means for a successful intubation when a failure with the WhL occurs. Although intubation of children aged 1-5 years takes longer with a BL than a WhL, the adult BL complemented the WhL laryngoscope in paediatric patients.

Adult↗
PubMed1997

The UpsherScope in routine and difficult airway management: a randomized, controlled clinical trial.

UNLABELLED: The UpsherScope, a rigid fiberoptic laryngoscope, may facilitate tracheal intubation. We performed a randomized, controlled trial of tracheal intubation using the UpsherScope and compared the success rate with that of direct laryngoscopy. Three hundred patients were randomly assigned to either fiberoptic oral intubation using the UpsherScope (Group US, n = 148) or to direct laryngoscopy (Group DL, n = 152). No significant differences in airway variables were observed between the groups. US intubation was successful in 129 of 148 patients (87%). A second or third attempt was required in 15% and 3%, respectively, of the patients successfully intubated with US. The remaining patients were intubated using DL (n = 17) or the flexible fiberoptic bronchoscope (n = 2). The success rate of DL was significantly higher (97%; P < 0.05), with a second or third attempt required in only seven patients. Time needed to perform successful intubation was 50 +/- 41 s for the US group compared with 23 +/- 13 s for the DL group (P < 0.05). We found no advantage of the UpsherScope over direct laryngoscopy during routine and difficult airway management. Time needed, number of attempts required to perform intubation, and incidence of failure were significantly longer and higher in group US. IMPLICATIONS: We studied tracheal intubation using the fiberoptic UpsherScope and compared the success rate with that of a control group of patients intubated using conventional laryngoscopy. No advantages of the new device were found. On the contrary, time needed, number of attempts required, and incidence of failure were even longer and higher.

Adult↗
PubMed1992

Thiopental pharmacodynamics. II. Quantitation of clinical and electroencephalographic depth of anesthesia.

This study examined the relationship among pseudo-steady-state (constant) serum thiopental concentrations, clinical anesthetic depth as assessed by several perioperative stimuli, and the electroencephalogram (EEG). Twenty-six ASA physical status 1 or 2 patients participated in the study. Two constant serum thiopental concentrations were maintained in each patient using a computer-controlled infusion pump. The first randomly assigned target serum concentration of 10-30 micrograms/ml was maintained for 5 min to allow serum:brain equilibration. Then the following stimuli were applied at 1-min intervals: verbal command, tetanic nerve stimulation, trapezius muscle squeeze, and laryngoscopy. A second, higher, randomly assigned target serum concentration of 40-90 micrograms/ml was then achieved and maintained by the computer-controlled infusion pump. The previously described stimuli were reapplied, after which laryngoscopy and intubation was performed. A positive response was recorded if purposeful extremity movement or coughing was observed. Using the quantal movement or cough response and the measured constant serum thiopental concentration, the probability of no movement to each stimulus was characterized using logistic regression. The serum thiopental concentrations that produced a 50% probability of no movement response for the clinical stimuli were as follows: 15.6 micrograms/ml for verbal command, 30.3 micrograms/ml for tetanic nerve stimulation, 39.8 micrograms/ml for trapezius muscle squeeze, 50.7 micrograms/ml for laryngoscopy, and 78.8 micrograms/ml for laryngoscopy followed by intubation. The EEG was analyzed using aperiodic waveform analysis to derive the number of waves per second. A biphasic relationship between constant serum thiopental concentration and the EEG number of waves per second was observed. Loss of responsiveness to verbal stimulation occurred when the EEG was activated at 15-18 waves/s.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Anesthetic depth defined using multiple noxious stimuli during isoflurane/oxygen anesthesia. II. Hemodynamic responses.

BACKGROUND: The hemodynamic effects of isoflurane have been studied extensively. However, most data are obtained from volunteers or patients in the absence of surgical stimulation. The hemodynamic responses to various stimulation patterns of different intensity have not been evaluated. METHODS: In 26 patients, the ability of isoflurane to suppress motor and hemodynamic reactions in response to noxious stimulations of variable degree (trapezius squeeze, tetanic stimulation, laryngoscopy, skin incision, and laryngoscopy plus intubation) was evaluated by measuring arterial blood pressure and heart rate before and after stimulation. RESULTS: At concentrations that inhibited motor response to these stimuli in 50% of all patients, systolic blood pressure increased by 9 (trapezius squeeze), 15 (tetanic stimulation), 23 (laryngoscopy), 35 (skin incision) and 49 (intubation) mmHg, and heart rate by 5 (trapezius squeeze), 15 (tetanic stimulation), 17 (laryngoscopy), 36 (skin incision), and 36 (intubation) min-1 compared to the prestimulation values. An analysis using multiple regression showed that blood pressure response was influenced most by the type of stimulation followed by the concomitantly occurring motor reaction, the anesthesia time, and least by the isoflurane concentration per se. A high isoflurane concentration had no influence on the magnitude of blood pressure or heart rate increase to stimulation, but it decreased the prestimulation blood pressure and slightly increased the prestimulation heart rate. Heart rate responses were less consistent than those of blood pressure. CONCLUSIONS: Isoflurane used as a sole agent is unable to suppress hemodynamic reactions (blood pressure and heart rate) to painful stimuli. A "normal" blood pressure following stimulation can be achieved only if prestimulation blood pressure is depressed to levels that may be clinically unacceptable. The lack of motor response is not an accurate predictor of the ability of an agent to depress hemodynamic reaction.

Adult↗
PubMed2006

Learning and performance of tracheal intubation by novice personnel: a comparison of the Airtraq and Macintosh laryngoscope.

Direct laryngoscopic tracheal intubation is taught to many healthcare professionals as it is a potentially lifesaving procedure. However, it is a difficult skill to acquire and maintain, and, of concern, the consequences of poorly performed intubation attempts are potentially serious. The Airtraq Laryngoscope is a novel intubation device which may possess advantages over conventional direct laryngoscopes for use by novice personnel. We conducted a prospective trial with 40 medical students who had no prior airway management experience. Following brief didactic instruction, each participant took turns in performing laryngoscopy and intubation using the Macintosh and Airtraq devices under direct supervision. Each student was allowed up to three attempts to intubate in three laryngoscopy scenarios using a Laerdal Intubation Trainer and one scenario in a Laerdal SimMan Manikin. They then performed tracheal intubation of the normal airway a second time to characterise the learning curve for each device. The Airtraq provided superior intubating conditions, resulting in greater success of intubation, particularly in the difficult laryngoscopy scenarios. In both easy and simulated difficult laryngoscopy scenarios, the Airtraq decreased the duration of intubation attempts, reduced the number of optimisation manoeuvres required, and reduced the potential for dental trauma. The Airtraq device showed a rapid learning curve and the students found it significantly easier to use. The Airtraq appears to be a superior device for novice personnel to acquire the skills of tracheal intubation.

Airway Obstruction↗
PubMed1998

Vocal cord dysfunction in three children--misdiagnosis of bronchial asthma?

Vocal cord dysfunction (VCD) is a paradoxical function of the vocal cords, leading to intermittent predominantly inspiratory dyspnea, but with no response to bronchodilator and anti-inflammatory drug therapy. We report on three children with VCD: 1) A 12-year old boy, who was treated for many years for bronchial asthma and who presented with inspiratory dyspnea and a functional reduction of the inspiratory and expiratory flow-volume curve, 2) a 13-year old girl who was also treated for bronchial asthma on a long-term basis and in whom the paradoxical vocal cord movement could be demonstrated by laryngoscopy, and 3) a 17-year old girl who, besides clinical symptoms of bronchial asthma in her anamnesis, suffered from an intermittent severe inspiratory dyspnea, refractory to bronchodilator treatment. Laryngoscopy proved the diagnosis of VCD. No patient showed a deterioration on discontinuation of their antiasthmatic therapy. VCD is best diagnosed by assessment of the vocal cords during laryngoscopy. The following therapeutic measures are helpful: 1) Demonstration of diagnosis (e.g. videodocumentation of laryngoscopy) and reassurance of patients and parents, 2) speech therapy, and 3) psychological intervention and/or psychotherapy. Our three cases point to a differential diagnosis of recurrent dyspnea in children and adolescents which may be overlooked. It is important to question earlier diagnoses, and to objectively evaluate the type of dyspnea.

Adolescent↗
PubMed1999

[Intravenous anesthesia with propofol in intracranial surgery].

OBJECTIVES: To analyze the repercussions of intravenous anesthesia with propofol as the single hypnotic drug on intracranial pressure (ICP) and cerebral perfusion pressure (CPP), and also to study the time until recovery from anesthesia and to tracheal extubation as well as intraoperative hemodynamic changes in patients undergoing surgery to remove a supratentorial brain tumor. PATIENTS AND METHODS: Twenty-three ASA I/II patients scheduled for exeresis of a supratentorial brain tumor were studied. A fiberoptic sensor placed in direct contact with the dura mater was used to measure ICP. Anesthetic induction was achieved with propofol (2 mg/kg). Propofol (12 and 9 mg/kg/h for 10 min and 6 mg/kg/h throughout the rest of the operation) was used for maintenance. Mean arterial pressure (MAP), heart rate (HR), ICP and CPP were recorded at baseline and 1, 2, 3 and 4 min after induction, during laryngoscopy and tracheal intubation; 1, 3, 5, 10, 15 and 20 min after tracheal intubation (L + 1, L + 3, L + 5, L + 10, L + 15, L + 20), upon placement of a craniostat; upon skin incision; upon withdrawal of propofol perfusion; and during extubation. The following variables were recorded after awakening: time until eye opening after receiving a verbal command, time until extubation and time until orientation. Analysis of variance for repeated measures (ANOVA) was performed on the results. RESULTS: MAP decreased significantly from baseline at the following times: during the post-induction period, upon placement of the craniostat, upon skin incision and when the propofol infusion was switched off. HR increased significantly during laryngoscopy and at the following moments: intubation, post intubation (L + 1, L + 3, L + 5), craniostat placement, and extubation. ICP was lower throughout the surgical period except during laryngoscopy, when this variable increased significantly. CPP decreased significantly after induction and returned to baseline after intubation. CPP was significantly higher after surgery. Recovery times after weaning from propofol infusion until eye opening in response to an order and until orientation were 13 +/- 3 and 22 +/- 4 min, respectively. The mean interval between withdrawal of propofol until extubation was 18 min. CONCLUSIONS: Intravenous anesthesia with propofol in intracranial surgery (supratentorial tumors) affords hemodynamic stability and lowers ICP except during laryngoscopy. Early recovery from anesthesia allows for neurological assessment and vigilance during the immediate postoperative period.

Adult↗
PubMed1999

Total intravenous anesthesia with propofol and remifentanil for elective non-cardiac surgery.

BACKGROUND: Remifentanil is a highly effective mu opioid agonist with predictable pharmacokinetics and a close concentration-effect relationship. Moreover, studies on anesthetic drugs interactions show that optimal propofol concentrations decrease more significantly with remifentanil as compared with other opioids and recovery appears to be much faster than when propofol is combined with other opioids combinations. This intervention study was designed to evaluate the efficacy of propofol combined with remifentanil in elective non cardiac inpatient surgery. METHODS: N. 405 patients undergoing intraperitoneal, head-neck, intrathoracic, major orthopaedics, breast and major vascular surgery received: remifentanil (1 microgram.kg-1 at induction; 0.50 microgram.kg-1.min-1 at laryngoscopy; 0.25 microgram.kg-1.min-1 at skin incision; 0.25-0.30 microgram.kg-1.min1 from skin incision to end of skin suture) and propofol (0.5-1 mg.kg-1 at induction; 5 mg.kg-1.h-1 at laryngoscopy; 5 mg.kg-1.h-1 at skin incision and 5 mg.kg1.h1 thereafter). Intraoperative end-points included somatic responses, tachycardia and hypertension to laryngoscopy and surgery. Incidence of intraoperative bradycardia, hypotension and muscle rigidity were also recorded. Postoperative end-points included Aldrete score > or = 9, pain immediately following emergence and PONV. RESULTS: Propofol-remifentanil combination effectively controlled responses to laryngoscopy and surgical stress. Drug related adverse events were transient bradycardia (< 50 bpm) and hypotension (SBP < or = 80 mmHg) respectively: at prelaryngoscopy 11.60-1.48% and at pre-skin incision 10.61-0.98%. N. 365 patients were discharged from PACU and the median time to first Aldrete score > or = 9 was 22.3 min. The most frequent postoperative event was shivering recorded in n. 46 patients (12%). Postoperative analgesic medication was requested by n. 16 patients (4.4%) and PONV was noted in n. 6 patients (1.6%). CONCLUSIONS: When combined with propofol, remifentanil effectively provided for profound analgesia during surgery, stable anesthetic conditions, simplicity of use and predictable recovery.

Anesthesia, Intravenous↗
PubMed2004

[Intubation using an illuminating stylet in a patient with a catecholamine-secreting paraganglioma].

Laryngoscopy and tracheal intubation produce intense noxious stimuli and are associated with an adrenergic response that can be deleterious in patients with concomitant diseases. Illuminating stylets effectively aid blind intubation by lighting the trachea, and using such devices has been associated with lower incidences of sore throat, dysphonia, and adverse hemodynamic events in comparison with rigid laryngoscopy. We report the case of a female patient with a catecholamine-secreting vagal paraganglioma. She developed multiple hypertensive episodes that were difficult to control during surgical resection of the tumor. It was decided to perform orotracheal intubation with a Light Wand (Vital Signs, Inc., Totowa, NJ, USA) to avoid oropharyngeal stimulation and to attenuate the hypertension and arrhythmias associated with laryngoscopy in such patients. The procedure was carried out without difficulty on the first attempt, in spite of tracheal displacement. The maximum increases in blood pressure and heart rate were observed 1 minute after intubation and were less than 30% of basal levels. We believe that using this light wand while intubating this patient helped keep the expected hemodynamic response to a minimum during laryngoscopy.

Carotid Body Tumor↗
PubMedDate not supplied

[Examination of the patient with supraglottic carcinoma at the medical office. Contribution of the rigid optical devices and the fiberscope].

Seventy one patients afflicted of supraglottic carcinoma were included in a prospective study whose purpose was to determine which of three optical tools available at the medical office--indirect mirror laryngoscopy, laryngotelescopy and fiberscopic examination--is the most suitable to examine the larynx of patients with this disease. No significant differences were found among these explorations in the easily observable regions, as the hypopharyngeal areas and the epilarynx. The examination of the pericommisural region--the most difficult area to see--was easier with the flexible fiberscope. The laryngotelescope provided better visualization than the mirror laryngoscopy. Exploration with the new optical devices did not correct the errors in the interpretation of images made with the mirror laryngoscopy. We conclude that flexible fiberoptic laryngoscopy provides better information than other diagnostic tools for the assessment of patients with supraglottic carcinoma at the medical office.

Carcinoma, Squamous Cell↗