LESSON 1: Eye, Ear, Nose, and Throat (EENT) Surgery

Section IV: THROAT, TONGUE, AND NECK SURGERY

1-35

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1-35. LARYNGOSCOPY

a. General. This procedure is a mode of direct visual examination of the interior of the larynx by means of an electric-lighted speculum known as a laryngoscope, in order to obtain a specimen of tissue or secretions for pathological examination or to instill a drug. Both psychological and drug preparation are needed in order to have the patient relaxed. An oral sedative is given the night before and again about an hour before the examination.

b. Setup. Check the surgeon's card for the exact equipment required. It will also be necessary to find out the type of anesthetic needed. Very small infants will probably not need an anesthetic; children and adults who cannot relax are given a general anesthetic; adults who are well prepared do very well with the application of a topical anesthetic of lidocaine (Xylocaine®), tetracaine (Pontocaine®) or cocaine.

c. Preparation of the Patient. The patient is placed in a supine position, and an assistant holds the patient's head in the proper position for good visualization of the vocal cords.

d. Operative Procedure.

(1) The spatula end of the laryngoscope is introduced into the right side of the patient's mouth and directed toward the midline; then the dorsum of the tongue is elevated, exposing the epiglottis.

 

(2) The patient's head is first tipped backward and then elevated and lifted upward as the laryngoscope is advanced into the larynx.

 

(3) The larynx is examined, a biopsy is taken, secretions are aspirated, and bleeding controlled.

 

(4) The patient's face is cleansed. The patient is reassured and taken to his room or the recovery room.

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