Figure - available from: Case Reports in Otolaryngology
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Rigid curved laryngoscope comprising a handle and a blade. The blade is curved along its entire length.
Source publication
Foreign body ingestion is a commonly encountered clinical problem. In particular, sharp foreign bodies lodged in the esophagus or hypopharynx can cause complications and require urgent removal. Removal by flexible esophagogastroduodenoscopy or rigid esophagoscopy is the treatment of choice and has high success rates, but cases in which these method...
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Esophageal foreign bodies ingestion is a worldwide surgical issue in pediatric age group while less likely in adults. We estimate endoscopic, clinical and therapeutic sides of this situation in the surgical department in Al-Hussein Teaching Hospital, Karbala city, Iraq and in Al-Sader Medical City, Najaf city, Iraq. The study made to revise our exp...
Citations
... However, this approach has not yet been applied in clinical practice. Moreover, material, fixation, and pipe size limitations have been reported with curved laryngoscopes, including rigid curved laryngoscopes and video laryngoscopes [13][14][15]. ...
Background
Suspension laryngoscopy (SL) is a common procedure performed by otolaryngologists. Studies have shown that adverse effects occur often during SL.
Objectives
To demonstrate the value of clinical application, this study compared the surgical time and postoperative oropharyngeal complications of SL using a novel curved video suspension laryngoscope with those of conventional SL.
Materials and methods
A total of 185 patients who underwent curved video SL, and 128 who underwent conventional SL were included. Characteristics including age, sex, body mass index (BMI), postoperative complications, and surgical time were compared in conventional and curved SL patients diagnosed with vocal cord polyps.
Results
The use of a curved laryngoscope significantly reduced surgical time (median, 10 min IQR 7–15 vs. 15 min IQR 11–20; p < .001) and produced fewer postoperative complications (2 vs. 39, p < .001) than that of conventional SL. Patients undergoing conventional SL experienced an 18.8-fold higher complication risk vs. those undergoing curved video SL (adjusted OR = 18.80; 95% CI = 6.47–54.60).
Conclusions and significance
Curved video SL provided a clear surgical field, consumed less surgical time, and yielded fewer complications than conventional SL. This procedure is a cost-effective, minimally invasive alternative to conventional SL.
... The advantages include good illumination, clear visualization, and precise extraction (3). The technique itself is efficient, safe, well tolerated, and with low morbidity, being analogous with the concept of the âȂIJfour hands techniqueâȂİ employed in various endoscopic surgeries (4). Despite the limited indication, this method may reduce limitations associated with non-invasive fishbone removal, the ingestion of which would most likely continue to accompany the eating habits of human societies. ...
... Computed tomography scans are valuable in patients presenting with suspected complications, such as soft tissue penetration, and in hypopharyngeal FFBs. 11,22 Some studies suggest that ultra-low-dose neck/chest CT using the iDose4 is an adequate first-line imaging modality for sharp esophageal FFBs before the endoscopic extraction. This imaging modality demonstrated 100% sensitivity and 97.8% specificity rates, thus allowing to keep a high image quality, while reducing the radiation dose. ...
... 16 Another option is the rigid curved laryngoscope, which has the advantage of full visualization in difficult sites, such as the hypopharynx, and allows the use of rigid forceps such as Magill forceps for retrieval. 22 In cases of FFB impaction leading to surface penetration of soft tissues, a surgical approach and intraoperative imaging such as ultrasound can be incorporated. 27,28 Another available option is the combination of endoscopic and surgical approaches, based on the site of impaction. ...
INTRODUCTION: Fish foreign body (FFB) impaction in the upper aerodigestive tract is a common cause for emergency department referral. Its management varies in both diagnosis and treatment paradigms. Fish bone foreign bodies are more common in the oropharynx in patients <40 years, and in the esophagus in patients >40 years. Symptoms are typically non-indicative for FFB location, with the exception of foreign body sensation at/superior to the cervical esophagus. Lack of findings in the physical examination is routinely followed by imaging, CT being the preferred modality. In practice, many patients undergo unnecessary imaging studies, including computerized tomography (CT) scans. OBJECTIVES: Identifying patients suspected of fish bone impaction who do not require CT imaging and can be safely discharged.
DATA SYNTHESIS: We searched the PubMed database for the following MeSH terms: ["fish bone", "fish foreign body"] AND ["oropharynx", "hypopharynx", "esophagus", "flexible esophagoscopy" and "rigid esophagoscopy"]. Our search in the English language yielded 32 papers. Case reports were included, since they high-lightened rare and serious complications.
CONCLUSION: In patients >40 years suspected of fish bone impaction, non-contrast CT is recommended and should be urgently performed, even in the presence of ambiguous symptoms. However, in patients <40 years presenting within 24 hours from ingestion, imaging has little diagnostic value due to the low probability of esophageal fish bones. For this specific subgroup in the absence of clinical findings, discharge without imaging studies may be considered safe.
... The most common sites for impaction are: the tonsils, tonsillar pillars, pharyngeal wall or the tongue base [1]. If not removed in a timely fashion, the fish bone may lead to significant morbidity and complications like deep neck infection, perforation of the esophagus, mediastinitis and even death [1,2]. Generally, a direct inspection of the oral cavity will pickup the fish bone in the tonsillar fossa, however, often only an ulcer is seen. ...
... Generally, a direct inspection of the oral cavity will pickup the fish bone in the tonsillar fossa, however, often only an ulcer is seen. Most fish bones are radiolucent, and may not be picked up by plain radiographs [2,3]. Meticulous examination and endoscopy with rigid or flexible scopes can help localize and remove the fish bone in these patients. ...
... We describe a novel method using a rigid curved laryngoscope for incision and drainage of a parapharyngeal abscess. is instrument was designed for laryngopharyngeal surgery under endoscopic vision [16,17] (Figure 3). Recent case reports have described successful removal of a fish bone in the hypopharynx and drainage of retropharyngeal abscesses using a rigid curved laryngoscope [18,19], which is useful for hypopharyngeal and oropharyngeal surgery. e blade is inserted into the pharynx and lifted forward. ...
Deep neck abscess is a life-threatening infection that causes laryngeal edema and upper airway occlusion. The predominant bacterial species involved in this disorder is group A streptococcus. Group G streptococcus (GGS) constitutes the normal commensal flora of the human upper airway. Although rarely, it can cause pharyngitis, tonsillitis, and peritonsillar abscess. Here, we report a case of a woman with parapharyngeal abscess caused by GGS. A 56-year-old woman presented to the emergency department with complaints of sore throat and cervical swelling, and a diagnosis of parapharyngeal abscess was established. She had upper airway occlusion, requiring urgent tracheostomy. Endoscopic incision and drainage of the abscess using a specially designed, rigid curved laryngoscope was successfully performed. Since a rigid curved laryngoscope creates a wide viewing field and working space, it was useful for incision and drainage of the parapharyngeal abscess.
... In East Asia, because whole fish is often served, difficult cases with a penetrating fish bone in the hypopharynx or the entrance of the esophagus are encountered frequently. A recent case report has described the successful removal of an impacted fish bone in the posterior wall of the hypopharynx transorally using this instrument [9]. ...
In endoscopic laryngo-pharyngeal surgery (ELPS), a rigid curved laryngo-pharyngoscope, which was invented by Dr. Sato et al., is necessary to obtain excellent surgical view of both hypopharynx and even the entrance of the esophagus. We have used this instrument for the examination and treatment of several diseases other than cancer located in the hypopharynx, such as difficult-to-find buried fish bones, retropharyngeal abscess, and congenital pyriform sinus fistula. In the result, we could acquire better view of hypopharynx and completed the intended procedure safely, especially for uncovering difficult-to-find fish bone buried in the mucosa. Even in the cases hardly to operate under this instrument, just use for detailed observation of the lesion was available. A rigid curved laryngo-pharyngoscope provides a wide and clear view of a challenging space, the hypopharynx. We recommend using this technique in cases such as difficult-to-find buried fish bones or retropharyngeal abscesses while avoiding a neck incision.
There are many cases of foreign bodies in the hypopharynx or esophagus that are removed using a flexible fiberoptic upper gastrointestinal endoscope, however, there are also cases in which, due to the shape and size of the foreign body and/or the anatomical problems, it is difficult to remove foreign bodies using a flexible fiberoptic endoscope. Conventional rigid esophagoscopy can sometimes be difficult due to the problem of a narrow visual field. In these case, the Sato rigid curved laryngoscope strongly lifts the larynx and provides a wide field of view and space at the entrance of the esophagus from the hypopharynx.
Herein, we report three cases in which removal of a foreign body could be safely performed using the Sato rigid curved laryngoscope under general anesthesia.
The Sato rigid curved laryngoscope is a useful device to safely observe and remove foreign bodies, as a large working space can be secured due to expansion of the lumen of the hypopharynx and cervical esophagus.
Aerodigestive tract fish bones are common and often utilize significant hospital resources. Some pharyngeal fish bones can be retrieved with basic equipment thus clinicians should exhaust all simple techniques including that described in this paper.
Laryngomicrosurgery with a suspension laryngoscope under general anesthesia requires cervical extension. Patients with cervical spondylosis cannot undergo cervical extension because of the risk of exacerbating their cervical issues. Videoendoscope-assisted laryngeal surgery with office-based equipment is often performed in such patients; however, there are some cases in which laryngeal surgery under general anesthesia is necessary. We herein report two patients with cervical spondylosis who underwent laryngeal surgery under general anesthesia with the aid of a rigid curved laryngo-pharyngoscope, which was accomplished with minimal cervical extension.
A 50-year-old woman with a laryngeal cyst and a history of cervical spondylosis and panic disorder presented to our hospital. A physical examination revealed a strong gag reflex. Laryngeal surgery under general anesthesia was undertaken with minimal cervical extension by means of a rigid curved laryngo-pharyngoscope. Her cyst was removed without aggravating her cervical spondylosis. The second patient was a 71-year-old man with vocal cord leukoplakia. He also had a history of cervical spondylosis. A physical examination revealed wide-spread leukoplakia. Laryngeal surgery under general anesthesia was also performed without aggravating his cervical spondylosis. Laryngeal surgery using a rigid curved laryngo-pharyngoscope is a new strategy for treating laryngeal disorders in patients with cervical issues.
