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Many neonates are referred for a diagnosis with stridor. The gold standard investigation has traditionally been a rigid or direct microlaryngoscopy. This impacts on existing theatre schedules, demands a high level of skills from the paediatric anaesthetist along with the risk of exposing a neonate to a general anaesthetic. A bed in paediatric intensive care is often required and must be reserved. As laryngomalacia is the most common diagnosis and less serious than the investigations for infants with stridor themselves, clinicians have been looking to use the flexible fibre-optic laryngoscope to view the upper airway in awake neonatal patients. We present our experience in 66 neonatal patients initially managed by awake per-oral flexible fibre-optic laryngoscopy for stridor. We conclude that the technique is safe, straightforward and allows a diagnosis to be achieved in a significant number of cases. We recommend it as a first line investigation, reserving microlaryngoscopy for the group of patients in whom a diagnosis cannot be made in the outpatient clinic. [ABSTRACT FROM AUTHOR]

The GlideScope® is a new video laryngoscope developed for management of the difficult airway. We compared the GlideScope with the Macintosh laryngoscope in simulated easy and difficult laryngoscopy. Twenty anaesthetists were allowed three attempts to intubate in each of four laryngoscopy scenarios in a high fidelity simulator. In the simulated easy laryngoscopy scenarios, the anaesthetists took longer to intubate using the GlideScope than the Macintosh laryngoscope (mean (SD) 19.0 (9.7) s vs. 12.7 (5.9) s, respectively; p = 0.006). There was no difference in the number of successful intubations, ease of intubation or choice of intubating device. In the simulated difficult laryngoscopy scenarios, the anaesthetists took less time to intubate using the GlideScope (23.5 (12.7) s vs. 70.5 (101.2) s, respectively; p = 0.001). The slightly higher success rate with the GlideScope was not statistically significant (20/20 vs. 18/20, respectively; p = 0.5). However, the anaesthetists found it easier to intubate using the GlideScope (median (interquartile range[range]) 1 (1–2[1–2]) vs. 2 (2–3[1–3]), respectively; p < 0.0001). [ABSTRACT FROM AUTHOR]

The impact of cricoid pressure on laryngoscopy is unknown. We have developed a quantitative method of recording the laryngoscopic view using a rigid, zero-degree endoscope. We found that an image matching the laryngoscopist's view could be obtained by positioning the endoscope along the laryngoscopist's‘line of sight’. Photographing this image allowed us to measure laryngeal exposure. We set out to define the effect of cricoid pressure on laryngoscopy using this method. In 40 patients undergoing elective surgery, laryngoscopy was performed with cricoid pressures of 0–60 N, increasing by increments of 10 N. We photographed the laryngoscopic view at each force and recorded dynamic images as cricoid pressure was released. The change in laryngoscopic view with increasing cricoid pressure fell into one of four broad patterns: little change (11 subjects); gradual deterioration (10 subjects); improvement at low force (< 20 N) followed by deterioration (9 subjects); improvement at high force (> 30 N) (10 subjects). We identified five subjects with a good initial view (anteroposterior length of the rima glottidis>5 mm) who showed a marked deterioration in laryngoscopic view as cricoid pressure increased; in three of these subjects this progressed to obscure the larynx completely at a force of 30 N, 40 N and 60 N, respectively. We conclude that the effect of cricoid pressure on laryngoscopy is complex. However, in some individuals, a force close to that currently recommended (30 N) may cause a complete loss of the glottic view. [ABSTRACT FROM AUTHOR]

A solution to managing intubation difficulties during anaesthesia induction is described in this article. After two attempts at laryngoscopy had failed, endotracheal intubation was achieved by the combined use of a laryngoscope and the Bonfils rigid fiberscope. The successful technique involved two anaesthesiologists, one who displaced the patients tongue to the left ventral part of the mouth with a laryngoscope and cleared the airway by suctioning, and one who accomplished the intubation using the Bonfils rigid fiberscope by following the blade of the laryngoscope to the larynx. After securing a good view of the vocal cords, the tube was successfully inserted into the trachea. The entire procedure of intubation was accomplished within 20s. [ABSTRACT FROM AUTHOR]

Objectives: Our objective was to document and compare the views obtained at laryngoscopy during emergency department (ED) rapid sequence intubation (RSI) by anesthetists and emergency physicians of varying seniority and experience. Methods: Data were prospectively collected on every intubation attempt in 7 urban Scottish EDs for 2 calendar years, commencing Jan. 11, 1999. Data included patient's age, gender, grade and specialty of intubator, laryngoscopic grade, and number of intubation attempts. Quality of laryngoscopic visualization was graded using the Cormack-Lehane scale, with grades I and II considered good visualization. A descriptive analysis was performed, and key statistical comparisons made. Results: During the study period, 735 patients underwent RSI, and grade of intubation was documented in 672 cases (91%). In total, 68.2%, 23.4%, 6.1% and 2.4% of the intubations were classified as Cormack-Lehane grade I, II, III and IV respectively. Overall, anesthetists and anesthesia trainees achieved good laryngoscopic visualization in 94.0% of cases (95% confidence interval [CI], 90.8%-96.4%) and emergency physicians and emergency medicine trainees did so in 89.2% of cases (95% CI, 85.5%-92.3%; p = 0.027). Specialist registrars and senior house officers in anesthesia were more likely to obtain good visualization than their emergency medicine counterparts (p = 0.034 and 0.035 respectively). Consultants in emergency medicine were more likely to obtain good views than their anesthesia counterparts, but this difference was not statistically significant. Conclusions: Anesthetic trainees obtain better laryngoscopic views than emergency medicine trainees, but these differences disappear with increasing emergency physician seniority, suggesting a training and experience effect. Emergency medicine trainees may benefit from additional focus on laryngoscopic visualization techniques early in their training period. [ABSTRACT FROM AUTHOR]

Objective To determine the efficacy of various eye protection measures during carbon dioxide laser laryngoscopy. Design A standard medical mannequin was equipped with indicator paper over the eyes and subjected to multiple passes of direct carbon dioxide laser beam contact at 400-mm focal length with powers ranging from 2.5 to 4.0 W during simulated laser microlaryngoscopy. Several different eye protection materials, including silk tape, paper tape, cloth tape, occlusive dressing, and eye pads, were used to cover the eyes and tested for their degree of protection against the laser beam. Thermal injuries were quantified and compared among these protective materials. Setting Academic medical center. Main Outcome Measure Degree of eye protection against the laser beam injury on a scale of 0 to 4. Results The carbon dioxide laser beam at both 2.5 and 4.0 W produced considerable thermal damage to the indicator paper in the absence of any protective barrier. Among the adhesive protective barriers, moistened cloth tape was the most effective adhesive material against laser beam–induced thermal damage (P<.001). Silk tape and paper tape offered poor protection. Moist eye pads, although not adhesive and therefore unable to maintain eye closure, were very effective barriers against the laser beam. Dry paper tape and dry eye pads were imminently flammable. Conclusion A combination of moistened cloth tape to maintain eye closure coupled with placement of well- moistened cotton-based eye pads over the tape provides excellent eye protection during carbon dioxide laser laryngoscopy. [ABSTRACT FROM AUTHOR]

The Cardiff paediatric laryngoscope blade is a single blade that has been designed for use in children from birth to adolescence. This open, randomised, crossover study compared the Cardiff blade with the straight, size 1, Miller laryngoscope blade in 39 infants under 1 years of age and the curved, size 2, Macintosh blade in 39 children aged 1–16 years. The same laryngoscopic view was obtained with the Cardiff and Miller blades in 26 patients; the view was better with the Cardiff blade in seven patients and better with the Miller blade in six (median (IQR[range]) grade of laryngoscopy 1 (1–2[1–3]) vs. 1 (1–2[1–3]), respectively; p = 0.405). The Cardiff blade was faster at gaining a view than the Miller blade (mean (SD) time 8.5 (2.9) s vs. 10.2 (3.5) s, respectively; 95% CI for difference−2.8 to−0.4; p = 0.009). The Cardiff and Macintosh blades produced the same view in 32 patients; the view was better with the Cardiff blade in seven patients (median (IQR[range]) grade of laryngoscopy 1 (1–1[1–3]) vs. 1 (1–2[1–3]), respectively; p = 0.008). There was no difference in time to gain these views: mean (SD) 8.7 (3.0) s vs. 9.3 (2.7) s, respectively (95% CI for difference−1.58 to 0.40; p = 0.237). The Cardiff paediatric laryngoscope blade compares favourably with these two established laryngoscope blades in children. [ABSTRACT FROM AUTHOR]

Three documents are provided to help the speech-language pathologist (SLP) identify children with voice disorders and educate family members. The first is a quickly administered screening test that covers multiple aspects of voice, respiration, and resonance. It was tested on 3,000 children in kindergarten and first and fifth grades, and on 47 preschoolers. The second document is a checklist of functional indicators of voice disorders that could be given to parents, teachers, or other caregivers to increase their attention to potential causes of voice problems and to provide the SLP with information pertinent to identification. The final document is a brochure with basic information about voice disorders and the need for medical examination, It may be used to help the SLP educate parents, particularly about the need for laryngeal examination for children who have been identified as having a voice problem. [ABSTRACT FROM AUTHOR]

The article reports a case of giant cell carcinoma of the hypopbarynx treated with chemoradiation and salvage laryngopharyngectomy and associated with fatal metastatic disease. A 48-year-old man presented in February 2000 with dysphagia, odynophagia, and hoarseness of 3 months duration. Indirect laryngoscopy revealed a large, exophytic mass arising in the right hypopharynx. Vocal cord mobility was unimpaired, and there was no lymphadenopathy. Examination under anesthesia demonstrated a necrotic, pedunculated tumour arising from the lateral portion of the right piriform apex. Sarcomatoid carcinomas of the lung form a group of poorly differentiated neoplasms composed of atypical spindle cells and/or giant cells, often associated with elements of conventional adenocarcinoma or squamous cell carcinoma.

The purpose of this study was to determine changes in the hypoglossal nerve function after suspension laryngoscopy with needle electromyography of the tongue. This study also attempted to determine the possible relationship between the predictive factors of intubation difficulty by using the intubation difficulty scale, which was introduced by Adnet et al., duration of suspension laryngoscopy and changes in hypoglossal nerve function after suspension laryngoscopy. The study was performed on 39 patients who underwent suspension laryngoscopy for benign glottic pathology. Pre-operative airway assessment was evaluated by the intubation difficulty scale and the duration of suspension laryngoscopy was recorded. Needle electromyography of the tongue was performed three or four weeks after the suspension laryngoscopy. After needle electromyography of the tongue, increased polyphasia was found in 13 patients (33 per cent), bilaterally in three of them. The interference pattern was reduced in two of these 13 patients. There was no statistically significant difference in predictive factors of intubation difficulty and the duration of the operation between these 13 patients with increased polyphasia and the remaining 26 patients with completely normal electromyography findings. These findings show that, in spite of normal clinical tongue function, subclinical changes can be detected by needle electromyography of the tongue after suspension laryngoscopy. [ABSTRACT FROM AUTHOR]

Objectives. – To analyze the frequency of systemic factors leading to secondary brain insults in victims of serious head trauma in a prehospital setting and to evaluate a protocol for the advanced prehospital emergency care by mobile intensive care unit (i.e., the French Samu–Smur system).Study design. – Prospective study, over a period of 24 months.Patients and methods. – This prospective study involved 60 victims of severe head injuries (with the exception of polytrauma patients). Tracheal intubation was performed on each patient under direct laryngoscopy and after induction of anaesthesia (fentanyl–etomidate–rocuronium). Controlled ventilation and vascular loading (objectives: SpO2 ≥ 97%, PETCO2 between 30 and 35 mmHg, SAP ≥ 90 mmHg) were administered.Results. – Hypoxaemia was found to be the most frequent cause of secondary insults (57% of patients with SpO2 < 97%). In the case involving an accident that occurred 17 km from the hospital (with extremes of 6–65 km), the speed of medical intervention was note-worthy: tracheal intubation was performed 50 min after the accident, and the patient was admitted into a trauma centre 101 min after impact (median). However, faster intervention could be obtained if the transmission of the alert was improved. The conditions under which the tracheal intubation was performed were found to be satisfactory (difficult intubation 1.6%) without deteriorating the haemodynamic status. This is probably related to the use of muscle relaxants and the choice of etomidate as the first line hypnotic in the prehospital emergency care. [Copyright &y& Elsevier]

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This article reports on an evidence-based review of laryngeal electromyography (EMG) as a technique for use in the diagnosis, prognosis, and treatment of laryngeal movement disorders including the laryngeal dystonias, vocal fold paralysis, and other neurolaryngological disorders. The authors performed a systematic review of the medical literature from 1944 through 2001 on the clinical application of EMG to laryngeal disorders. Thirty-three of the 584 articles met the predefined inclusion criteria. The evidence demonstrated that in a double-blind treatment trial of botulinum toxin versus saline, laryngeal EMG used to guide injections into the thyroarytenoid muscle in persons with adductor spasmodic dysphonia was beneficial. A cross-over comparison between laryngeal EMG-guided injection and endoscopic injection of botulinum toxin into the posterior cricoarytenoid muscle in abductor spasmodic dysphonia found no significant difference between the two techniques and no significant treatment benefit. Based on the evidence, laryngeal EMG is possibly useful for the injection of botulinum toxin into the thyroarytenoid muscle in the treatment of adductor spasmodic dysphonia. There were no evidence-based data sufficient to support or refute the value of laryngeal EMG for the other uses investigated, although there is extensive anecdotal literature suggesting that it is useful for each of them. There is an urgent need for evidence-based research addressing the use of laryngeal EMG for other applications. Muscle Nerve 28: 767–772, 2003 [ABSTRACT FROM AUTHOR]

In adjunct to direct laryngoscopy, CT and/or MRI are needed for an accurate staging of laryngeal and hypopharyngeal carcinomas because both cross-sectional imaging modalities are known to reliably evaluate deep tumor infiltration. Except for the clinical background, this article reviews technical aspects of CT and MRI, the pathologic appearance of laryngeal and hypopharyngeal carcinomas, and therapeutically relevant diagnostic aspects. [ABSTRACT FROM AUTHOR]

The article presents the most clinically effective new laryngoscopic design of the last few years, the McCoy laryngoscope. A number of recent advances in new airway devices are available and the most investigated, because of its certain advantages, includes the Combitube and the intubating laryngeal mask airway (ILMA). It also states that the cuffed oropharyngeal airway (COPA), because of its simple design, may have a new role in airway management when performed by non-anaesthetists.

In the current panorama the conclusive identification of a laryngeal pathology relies inevitably on the observation of the vocal folds by means of laryngoscopical techniques. This inspection technique is inconvenient for a number of reasons, such as its high cost, the duration of the inspection, and, above all, the fact that it is an invasive technique. This paper looks into the possibility of measuring the quality of a voice starting from an audio recording. The existing parameters in current literature ("classic parameters") which allow quantifying the quality of a voice have been studied, and the parameters that present better results have been selected. Also, seven new high order statistics (HOS) based parameters are proposed to parameterize the voice signal. On the other hand, a software package has been developed which carries out the automatic detection of dysfunction in phonation. A success rate of 98.3% has been obtained by using both the classic and the HOS based proposed parameters. [ABSTRACT FROM AUTHOR]

SummaryA study of 56 patients was undertaken to determine whether there is a difference in the effect of the laryngeal mask airway and the endotracheal tube on the vocal tract after short-duration anaesthesia. All the patients were interviewed pre- and post-operatively. In 43 patients, it was possible to assess the larynx using videoÍendoscopy and videostrobolaryngoscopy both pre- and post-operatively. Selected acoustic characteristics were investigated in 51 patients pre- and 18–24 h post-operatively. Thirty-four patients that did not have anaesthesia were used as an age-matched control. The interview showed, that patients in the LMA group complained less frequently of having post-operative laryngeal discomfort. The videostrobolaryngoscopy demonstrated minor lesions of the vocal tract in six patients in the ETT group and in one patient in the LMA group. Of the 12 voice variables evaluated, there was no significant difference in any parameter between the two groups. Both groups had a higher fundamental frequency post-operatively. [ABSTRACT FROM AUTHOR]

The purpose of this randomised single blinded study was to determine the optimal size of laryngeal mask airway in the normal adult population, to test the validity of the current selection criteria and to determine if any externally measured anatomical variable correlated with optimal size. In each of 30 apnoeic anaesthetised adults weighing less than 100 kg, size 3, 4 and 5 laryngeal mask airways were inserted in random order by a skilled user and the cuff inflated to a standard pressure (60 cmH2O). Optimal size was based on four criteria in order of priority: number of attempts at placement, oropharyngeal leak pressure, fibreoptic score and percentage of vocal cords seen. The size 5 laryngeal mask airway was optimal in 19/30 and the size 4 in 11/30. In no patient was the size 3 the optimal fit. Oropharyngeal leak pressure was significantly higher for each progressively larger size and the fibreoptic view was significantly better for the size 4 and size 5. There was no significant predictive value in any externally measured anatomical variable, but height was the most useful. The best current selection strategy was to choose a size 5 for males and size 4 for females. Potentially useful new strategies may be to use the size 5 in all adults, or a size 5 ≥ 165 cm in height and size 4 for < 165 cm. We conclude that predicting the optimal size of laryngeal mask airway for individual adult patients is complex. The best size selection strategies involve use of the size 4 and 5 laryngeal mask airways in adults. [ABSTRACT FROM AUTHOR]

Stridor in a newborn should necessitate an immediate work-up to rule out a life-threatening airway obstruction, Three cases of newborns with stridor are presented. These cases emphasize the need for an immediate and thorough physical examination of any stridorous newborn, followed by radiologic studies and direct laryngoscopy. While other invasive procedures are frequently required for a precise diagnosis, a careful examination with special attention to the quality of the stridor often permits a more effective diagnostic approach in an atmosphere of appropriate urgency. [ABSTRACT FROM AUTHOR]

Background: This study was conducted to determine an effective bolus dose of fentanyl, which would attenuate the cardiovascular response to laryngoscopy and tracheal intubation. Materials and Methods: A randomised double blind controlled study was carried out on 50 healthy adult patients (ASA I and II) undergoing elective surgery under general anaesthesia. The patients were randomly allocated into two groups of 25 each i.e. group A and group B receiving fentanyl 3 ug/kg, 5 ug/kg intravenously three minutes before intubation respectively. The pulse rate, systolic blood pressure was recorded at induction, during intubation and at 1,3, 5 min post intubation. Results: The study showed that both the doses were equally effective in blunting the pulse rate response, but the 5μg /kg proved significantly effective in blunting the blood pressure response. The rate pressure product, a measure of cardiac O2 consumption was found to be significantly lower in fentanyl 5μg/kg compared to fentanyl 3ug/kg. Conclusion: So, we conclude that both blood pressure and rate pressure product were completely abolished by a bolus dose of fentanyl 5μg /kg in comparison with fentanyl 3μg/kg following laryngoscopy and intubation. [ABSTRACT FROM AUTHOR]

Video laryngoscope (VL) provides excellent laryngeal exposure in patients when anaesthesiologists encounter difficulty with direct laryngoscopy. Videolaryngoscopy, like flexible fibreoptic laryngoscopy demands a certain level of training by practitioners to become dexterous at successful intubation with a given instrument. Due to their cost factors, VLs are not easily available for training purposes to all the students, paramedics and emergency medical services providers in developing countries. We tried to develop a cost-effective instrument, which can work analogous to various available VLs. An inexpensive and easily available instrument was used to create an Airtraq Model for VL guided intubation training on manikin. Using this technique, successful intubation of manikin could be achieved. The Airtraq Model mimics the Airtraq Avant ® and may be used for VL guided intubation training for students as well as paramedics, and decrease the time and shorten the learning curve for Airtraq® as well as various other VLs. [ABSTRACT FROM AUTHOR]

The article explores the emergence of videolaryngoscopy as a standard method for tracheal intubation in the intensive care unit (ICU). Several studies examined the application of videolaryngoscopes in the ICU, including a videolaryngoscope with a Macintosh-like blade. A study noted the association of difficult intubation with direct laryngoscopy using the Macintosh technique. Complications of the use of conventional laryngoscopes and video laryngoscopes are compared.

Direct laryngoscopy is an essential examination for supraglottic and laryngeal pathology. Fibreoptic or videolaryngoscope are not readily available. This study was designed to see the usefulness of Videogastroscope to evaluate laryngeal lesion instead of fibreoptic or videolaryngoscope. Patients with unsuccessful or unsatisfactory indirect laryngoscopic examination referred by ENT surgeons were examined using videogastroscope and anaesthetizing oropharynx and hypopharynx with lidocaine pharyngeal spray. Under direct supervision impressions including still and dynamic images were recorded. Study group comprised of 76 males and 43 females with age varying from 09 to 87 with mean age 44 years. Various abnormalities were detected among 74 (62.2 %) patients. Common pathologies were vocal cord polyps and nodules in 28, laryngitis and laryngeal ulcer in 16, supraglottic growth in 13 and pyriform fossa growth in 10. Direct laryngoscopy using videogastroscope is safe, effective and easily performed newer technique which might be very useful where indirect laryngoscopy is difficult and fibreoptic or videolaryngoscope is not available. [ABSTRACT FROM AUTHOR]

Background Foreign bodies traversing the aerodigestive tract lining into the surrounding soft tissues is a well-known entity. A 14-year-old girl was referred to our hospital after swallowing a pin that was not visualized by laryngoscopy, despite a neck film that localized it to the level of the larynx. Methods A CT scan demonstrated a bent pin piercing the left vertebral artery 'through and through,' and this was confirmed by angiography. The pin was extracted via an external approach to the neck without preoperative intravascular manipulation. Results Angiography immediately after the surgery demonstrated a stable thrombotic sleeve in the vertebral artery without further clot propagation or bleeding from the vessel wall. This is the first report of a 'through and through' thrombotic sleeve in an artery. Conclusions Simple surgical removal of a sharp foreign body from the vertebral artery without intravascular management may be a reasonable option. © 2010 Wiley Periodicals, Inc. Head Neck, 2012 [ABSTRACT FROM AUTHOR]

The article presents a study on laryngoscopy using C-MAC video laryngoscope. It discusses findings on the application of cricoid pressure by an assistant to see the video monitor on patients undergoing elective general anaesthesia. It explores the importance of the research for improving the laryngoscopic views and intubating conditions.

The article presents a study that compares STORZ DCI Videolaryngoscope and direct laryngoscopy in simulating a normal and difficult airway tool. The study uses a mannequin with a simulated difficult airway and primary results are taken on the percentage of glottic opening seen and those data are analyzed using paired t-test. It is inferred that time to intubate (TTI) is significantly longer in videolaryngoscopy group (VL) compared to direct laryngoscopy (DL) in experienced and novice groups.

We have developed a special purpose adaptor making it possible to use a commercially available high-speed camera to observe vocal fold vibrations during phonation. The camera can capture dynamic digital images at speeds of 600 or 1200 frames per second. The adaptor is equipped with a universal-type attachment and can be used with most endoscopes sold by various manufacturers. Satisfactory images can be obtained with a rigid laryngoscope even with the standard light source. The total weight of the adaptor and camera (including battery) is only 1010 g. The new system comprising the high-speed camera and the new adaptor can be purchased for about $3000 (US), while the least expensive stroboscope costs about 10 times that price, and a high-performance high-speed imaging system may cost 100 times as much. Therefore the system is both cost-effective and useful in the outpatient clinic or casualty setting, on house calls, and for the purpose of student or patient education. [ABSTRACT FROM AUTHOR]

The article presents the case of a healthy 32-year-old male professional hockey player who was kicked at the neck by a teammate's skate during a game. It notes that the player was said to have pulsatile bleeding that could only be controlled with firm, direct pressure, suggesting a laceration to the common carotid artery. At the operating room, it states that the vascular surgery team performed an exploration of the neck wound and assessed the injury in detail. It adds that after the arterial repair process was performed, the patient underwent a laryngoscopy and esophagoscopy.

A letter to the editor is presented which proposes checklist of anatomical features for flexible nasolaryngoscopy.

We reported of the extremely rare adult case with hemangiomas of the vocal cord. Larengeal hemangiomas is the most common disease in infantile patients, and respiratory distress is a main symptom in this entity. But adult hemangiomas in vocal cord are very rare conditions, and hoarseness is a main symptom. A 40 years old man with hoarseness and slight difficulty in breathing was presented . Diagnostic investigation revealed a pink-purple mass which was mobile with respiration and extended from the anterior comissure to the posterior part of vocal cord. Direct laryngoscopy was performed, and it was totally excised. There was no recurrence in one year follow-up period. [ABSTRACT FROM AUTHOR]

Abstract: Damage to the teeth during general anaesthesia is a frequent cause of morbidity for patients and a source of litigation against anaesthetists. Most injuries occur as a result of laryngoscopy. The use of an oropharyngeal airway as a bite block can increase the risk of dental damage and should be avoided. Bite blocks should be made from an appropriate material and placed between molar teeth rather than incisors. Patients should be advised about the possibility of dental trauma during anaesthesia and should be advised to have preoperative dental treatment to minimize dental factors that increase the risk of injury. Children in a mixed dentition phase (between the ages of about 5–12 years) are a high-risk group. Anaesthetic departments should have local protocols to refer patients for dental treatment postoperatively in the event of trauma. [Copyright &y& Elsevier]

Schwannomas also known us Neurilemmomas are benign encapsulated, slow growing perineural tumours of Neuro-ectodermal origin that arise from the sheet of Schwann cells. Two cases are being presented due to their rarity and in both cases the diagnosis was arrived at after the excision of the tumour. [ABSTRACT FROM AUTHOR]

We report the use of dexmedetomidine for laryngoscopy, rigid bronchoscopy, and tracheal extubation in the operating room in two children who had undergone tracheal reconstruction 1 week previously. Dexmedetomidine in combination with propofol provided appropriately deep anesthesia during these brief but stimulating procedures without cardiovascular or respiratory depression. [ABSTRACT FROM AUTHOR]

Objectives: Fiberoptic endoscopic evaluation of swallowing with sensory testing has been used to assess the integrity of laryngopharyngeal sensory and motor components. The pharyngeal squeeze is a maneuver used during fiberoptic endoscopic evaluation of swallowing with sensory testing to assess pharyngeal motor function. Although the pharyngeal squeeze manuever has been used in numerous scientific publications, its reliability has not been critically evaluated. Therefore, we sought to evaluate the reliability of the pharyngeal squeeze maneuver. Methods: Forty individuals who were undergoing fiberoptic laryngoscopy for various reasons were instructed to perform the pharyngeal squeeze maneuver. Three different clinicians reviewed the videotape on 4 separate occasions. The clinicians were first asked to rate each side of the pharynx as normal, diminished, or absent. They were then instructed to simply rate the maneuver as normal or abnormal. The interobserver and intraobserver reliability of the pharyngeal squeeze maneuver were assessed with the kappa coefficient. Results: The mean age of the cohort was 58 years. Fifty-eight percent (23 of 40) were male. When the clinicians were instructed to rate each side of the pharynx as normal, diminished, or absent, the interobserver and intraobserver reliabilities were poor (63% to 68% agreement; kappa = 0.18 to 0.67). When the clinicians were asked to rate the pharyngeal squeeze maneuver as normal or abnormal, both interobserver and intraobserver reliabilities were excellent (85% to 98% agreement; kappa = 0.75 to 0.95). Conclusions: The pharyngeal squeeze maneuver displayed poor reliability when motor function was classified into unilateral or bilateral normal, diminished, and absent categories. The pharyngeal squeeze maneuver was very reliable when simply graded as normal or abnormal. Clinicians could not reliably distinguish between diminished and absent pharyngeal motor functions. [ABSTRACT FROM AUTHOR]

Bilateral vocal fold immobility is an uncommon but serious condition with many causes. Accordingly, accurate diagnosis is essential in order to treat patients promptly and avoid long-term sequelae. Historically, diagnosis has been performed in the operating room with the patient under general anesthesia. We present the case of a patient who was diagnosed with bilateral vocal fold immobility by in-office arytenoid palpation that required only topical anesthesia of the larynx. The patient subsequently underwent appropriate treatment. In our opinion, office-based arytenoid palpation is a simple, safe, and accurate procedure for diagnosing bilateral vocal fold immobility. [ABSTRACT FROM AUTHOR]

Abstract: The Macintosh laryngoscope is very successful but there are several alternative methods of tracheal intubation. Many of these depend on advances in fibre-optic technology, which allow better visualization of the glottis when line of sight tactics are impossible. The flexible fibre-optic laryngoscope is the best known device, but a new generation of rigid and malleable fibre-optic endoscopes is appearing; they offer better optics, easier cleaning and are more robust. Video systems are also available, in which a camera is mounted distally on a flexible or rigid instrument and the image displayed on a small television screen. ‘Blind’ techniques are also useful when blood, secretions or debris prevent vision. The various alternatives are described and illustrated. [Copyright &y& Elsevier]

Failed tracheal intubation due to a difficult airway is an important cause of anaesthetic morbidity and mortality. This study was undertaken to evaluate the effectiveness of the Bonfils intubation fibrescope for tracheal intubation after failed direct laryngoscopy. Twenty-five patients undergoing coronary artery bypass grafting were enrolled in the study after two attempts at conventional laryngoscopy by a board certified anaesthetist had failed. Intubation with the Bonfils fibrescope was successful on the first attempt in 22 patients (88%) and on the first or second attempt in 24 patients (96%); in one patient intubation was impossible. Median (IQR[range]) time to intubation using the Bonfils intubation fibrescope was 47.5 (30–80[20–200]) s. Tracheal intubation using the Bonfils intubation fibrescope appears to be a simple and effective technique for the management of a difficult intubation. [ABSTRACT FROM AUTHOR]

There has been no report describing suspected prenatal pyriform sinus (PS) cyst and fistula. We report a case suspected by prenatal ultrasonography and fetal MRI. A large cystic mass was found in the left neck of the fetus. After the baby was born, preoperative laryngoscopic catheterization of the fistula tract was used to confirm the diagnosis and greatly facilitated the identification and excision of the PS cyst and fistula. [ABSTRACT FROM AUTHOR]

The laryngeal paraganglioma (LP) is a rare neuroendocrine neoplasm which arises from paraganglionic tissue normally present in the larynx. Immunohistochemistry is essential in the differential diagnosis of the various neuroendocrine neoplasms. The study presents a case of LP arising in an otherwise healthy 30-year-old black woman. Direct laryngoscopy revealed a large mass obstructing the airway almost completely. The patient underwent a total laryngectomy. Histopathological examination showed a population of epithelioid cells arranged in round nests and balls surrounded by a delicate stroma (‘Zellballen’ pattern). The histological and immunohistochemical patterns were coherent with LP. At 24 months after excision, she shows no evidence of disease.Copyright © 2005 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Posterior laryngeal cleft (PLC) is a rare developmental abnormality, which requires early diagnostic laryngoscopy and management if considerable morbidity and mortality are to be avoided. We report the case of a 25-year-old man with a life-long history of a weak, breathy voice, in whom the diagnosis of PLC was made by CT scanning. This is the first reported case of a PLC being diagnosed by CT scanning. Whilst direct laryngoscopy should remain the investigation of choice in congenital stridor, CT scanning may occasionally be useful. [ABSTRACT FROM AUTHOR]

The article discusses research which showed that an inverted-V shape in transverse ultrasonographic laryngeal anatomy would identify the thyroid cartilage and allow cricothyroid membrane localisation. It explains the consequence of inaccurate cricothryoid and how ultrasonography can improve membrane localisation accuracy. It notes the similar appearance of the membrane's air-tissue border to that of the cricoid cartilage air-tissue border.

Presents information on a study which examined the effectiveness of neonatal finger intubation of the trachea. Background on the intubation method; Methodology; Results of the study.

This article reports on the case study related to lipoid proteinosis. The subject was a M.C, male, aged 8 years, and K.C., female, aged 10 years. The subject K.C.'s voice was noticed to be hoarse and whisper-like following laryngitis when aged 12 months. Thickening of lower lip was first noticed at the age of 13 months, after laceration of her lip by her teeth following a fall. Laryngoscopy when the patient was 4 showed oedema of the vocal cords. By this titne small pitted scars on the face and nodular thickening of the eyelid margins were present as well as the infiltrations ofthe mucous membrane ofthe lips.

A case study of a 23-year-old man sustained with brain injury after motor-vehicle accident is presented. Topics discussed include use of endotracheal intubation for an elective procedure under general anaesthesia, his complaints of intermittent stridor on exertion, and use of flexible nasopharyngolaryngoscope for clinical and endoscopic examinations of the larynx.

Objectives: To assess the efficacy of ultrasound-guided laryngeal air column width difference in predicting postextubation stridor in children. Design: Prospective observational study. Setting: Single, tertiary care pediatric hospital. Patients: This study was carried out at PICU and surgical ICU, Tanta University Hospital on 400 ventilated children between January 2015 and May 2017. Patients who received mechanical ventilation and met criteria for a weaning trial were included. Intervention: Laryngeal ultrasound and cuff leak test. Measurements and Main Results: Ultrasound-guided laryngeal air column width and cuff leak test were measured before extubation. Laryngeal air column width is the width of air between the vocal cords seen by laryngeal ultrasonography. Laryngeal air column width difference is the width difference of air column passed through vocal cords with the balloon cuff inflated and deflated. Three-hundred fifty six patients (89%) had no postextubation stridor, whereas 44 patients (11%) developed postextubation stridor. Postextubation stridor was associated with younger age, less weight, female gender, prolonged duration of intubation, and ICU stay (p < 0.05). Both laryngeal air column width difference and cuff leak test showed significant decrease (p < 0.05) in patients with postextubation stridor in comparison with no postextubation stridor patients. Receiver operating characteristics curve analysis showed that laryngeal air column width difference at cutoff point of less than 0.8 mm gave a sensitivity of 93%, specificity of 86%, and accuracy of 91%, whereas cuff leak test at less than 11% yielded a sensitivity of (61%), specificity of (53%), and accuracy of (59%) for predicting postextubation stridor. Conclusions: Laryngeal air column width difference measurement may serve as a simple reliable noninvasive method for predicting postextubation stridor in children. [ABSTRACT FROM AUTHOR]

The article presents the case of an elderly man who presented for elective laparoscopic cholecystectomy under general anesthesia. Topics discussed include the limitations of hyperangulated videolaryngoscope blades, such as the Glidescope videolaryngoscope® from Saturn Biomedical Systems. A way to address the mismatch between the Glidescope videolaryngoscope® and the D-balde C-MAC videolaryngoscope by pairing the D-blade C-MAC with a Frova Intubating Introducer® is also discussed.