LARYNGOSCOPY

Ans:C i.e. The laryngoscope is lifted upward levering over the upper incisiors.

Procedure of Endotracheal Intubation:

• The correct position is with the lower part of the cervical spine flexed (by placing a pillow or other suitable pad under the patient’s occiput), and the atlanto-occipital joint extended(by tilting the head back) – the so-called “sniffing position”. This position aligns the axes of the mouth, pharynx and trachea, and will give the best visualization of the cords during laryngoscopy.
• In a Straight Blade Laryngoscope,lift the epiglottis with the tip of the blade.

Ci.e. Pollarad tube with infiltration block

– Microlaryngoscopy tubes are long, have a small internal and external diameter, and are designed specifically for endoscopic procedures (but not suitable for laser surgery). Typically 4 to 5 mm internal diameter tubes with high volume, low-pressure cuffs are used in nasal or oral versions. The most popular anaesthetic technique uses a Coplan’s micro laryngoscopy tube (5mm ID, 31cm long, 10mm cuff volume and constructed from soft plastic). It is designed for micro laryngeal surgery or for the patient whose airway has been narrowed to such an extent that a normal-sized tracheal tube cannot be inserted. The small tube diameter provides better visibility and access to the surgical field but may lit incomplete exhalation and occlusion.

– Most commonly the patients are intubated with small diameter (4 – 6 mm) tracheal tubes; – Standandard tracheal tubes of this size, however, are designed for pediatric patients. They tend to be too short for adult trachea (in length) with a low volume cuff that will exert high pressure against it

– A 4 – 6 mm micro laryngeal tracheal (MLT) tubes (Mallinckrodt critical Care) is the same length as the adult tube, has disproportionately large high volume low-pressure cuff, and is stiffer and less prone to compression than a regular tracheal tube.

Larynx: Epiglottis, aryepiglottic folds, arytenoids, cuneiform and corniculate cartilage, ventricular ands, ventricles, true cords, anterior commissure, posterior commissure, subglottis and rings of trachea.

Hypopharynx: Both pyriform fossae, post-cricoid region, posterior wall of laryngopharynx.

Oropharynx: Base of tongue, lingual tonsils, valleculae, media and lateral glosso-epiglottic folds.

Hidden areas of larynx viz. infrahyoid epiglottis, anterior commissure, ventricles and subglottic region and apex of pyriform fossa are difficult to visualize by indirect laryngoscopy.

The present day microsurgical techniques of the larynx are a credit to Kleinsasser.

Microlaryngoscopy concentrates mainly on the glottic area in cases where the diagnosis is already established and unlike direct laryngoscopy, is not primarily concerned with other areas of larynx which should have been assessed preoperatively.

The management is microlarygoscopic surgery using CO, laser to ablate the lesion.

Steroids and antibiotics have no role.

Tracheostomy is reserved for those patients who have severe respiratory distress.

Answer- Nasopharyngoscopy

The image represents Posterior rhinoscopy test

Posterior Rhinoscopy:

• It is method of examination of the Nasopharynx.
• Structures seen on posterior rhinoscopy:

– Both choanae

– Posterior end of nasal septum

– Opening of Eustachian

– Posterior end of superior/tube middle and inferior turbinates

– Fossa of Rosenmuller

– Torus Tubarius

– Adenoids

– Roof and posterior wall and nasopharynx.

Different methods of examining the Nasopharynx 

i. Posterior Rhinoscopy

ii. Nasopharyngoscopy.

iii. Examination under anaesthesia after palatal retraction.

iv. Digital palpation.

v. Radiological examination.

Ans. is ‘a^‘ i.e., I ntubation & laryngoscopy