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ENDOSCOPY OF THE
LARYNX, BRONCHUS,
AND ESOPHAGUS
Julie G. Cebrian, MD, FPSO-HNS
Introduction
1. Laryngoscopy
a. Indirect
b. Direct
2. Bronchoscopy
a. Rigid
b. Flexible
3. Esophagoscopy
a. Rigid
b. Flexible
Laryngoscopy
History :
Manuel Garcia 1830s
- first to successfully visualize
the larynx using dental mirror
and sunlight
Late 1800s Mckenzie, Jackson
and Hollinger
- design and modification of the
rigid endoscopes
Laryngoscopy
History
:
1930s advent of fiber optic illumination
1960s
flexible endoscopes
INDIRECT MIRROR
Laryngoscopy
Probably the most important outpatient
diagnostic procedure for examining the larynx
Its biggest drawback is a tendency to cause
gagging in some patients
It may also not adequately allow for
visualization of the anterior commissure
INDIRECT MIRROR
Laryngoscopy
Indications:
1. Hoarseness
2. Problems associated with the protection of
the respiratory tract during swallowing
3. Cervical lymphadenopathy of unknown origin
4. Earache with normal examination findings
INDIRECT MIRROR
Laryngoscopy
Equipment:
1. Laryngeal Mirror
2. Head mirror with light source
3. Gauze
INDIRECT MIRROR
Laryngoscopy
Technique:
DIRECT Laryngoscopy
DIRECT Laryngoscopy
I. Flexible Fiberoptic Laryngoscopy
Performed under local
anesthesia
Excellent for evaluating larynx
of trauma patient with
suspected cervical fracture
Can be used to evaluate
trachea and bronchi among
laryngectomized patients
DIRECT Laryngoscopy
I. Flexible Fiberoptic Laryngoscopy
DIRECT Laryngoscopy
II. Videolaryngoscopy
Equipment:
1. Laryngeal endoscope 70 and 90
2. Video camera
3. Video adapter
4. Light source and cable
5. Video recorder and monitor
DIRECT Laryngoscopy
II. Videolaryngoscopy
Technique:
DIRECT Laryngoscopy
II. Videolaryngoscopy
Advantage over Flexible Laryngoscopy
1. Clearer, sharper, brighter, larger images
2. Documentation of precise anatomic or
structural changes of the larynx
3. Clear video image and high resolution
DIRECT Laryngoscopy
III. Direct Rigid Laryngoscopy
Indications:
1. Staging and biopsy of laryngopharyngeal
lesions.
2. Rule out a second primary tumor or as a part
of the work-up of metastatic tumors of unknown origin
3. For patients in whom flexible laryngoscopy is
not possible
DIRECT Laryngoscopy
III. Direct Rigid Laryngoscopy
Indications:
4. Patients presenting with displaced or open
laryngeal fracture
5. Provides surgical approach
DIRECT Laryngoscopy
III. Direct Rigid Laryngoscopy
Instruments:
DIRECT Laryngoscopy
III. Direct Rigid Laryngoscopy
Technique:
DIRECT Laryngoscopy
III. Direct Rigid Laryngoscopy
Technique:
DIRECT Laryngoscopy
III. Direct Rigid Laryngoscopy
Complications:
1. Laryngeal edema
2. Bleeding
3. Airway compromise
4. Tooth fracture / avulsion
Direct laryngoscopy
FOREIGN BODY
Direct laryngoscopy
FOREIGN BODY
3 cm fishbone
BRONCHOSCOPY
Bronchoscopic Anatomy:
Trachea begins immediately
inferior to cricoid cartilage
Hollow tube 5 inches or 13 cms long
Supported by U-shaped bars of hyaline
cartilages
Divides into 2 main bronchi at the
carina
BRONCHOSCOPY
Bronchoscopic Anatomy:
Principal Bronchi
1. Right
Wider
Shorter (1 inch )
More vertical
2. Left
Narrower
Longer (2 inches)
More horizontal
BRONCHOSCOPY
Bronchoscopic Anatomy:
Secondary Bronchi
Lobar bronchus
Tertiary Bronchi
Segmental Bronchi
Gives rise to the
bronchopulmonary
segments
BRONCHOSCOPY
Bronchoscopic Anatomy:
BRONCHOSCOPY
History :
Gustave Killian 1897
BRONCHOSCOPY
History :
Ikeda and associates 1968
Flexible Bronchoscope
BRONCHOSCOPY
Equipment :
Rigid Bronchoscopes
BRONCHOSCOPY
Indications :
A. Diagnostic
1.
Hemoptysis
2.
3.
Transbronchial biopsy
4.
Infectious process
5.
6.
BRONCHOSCOPY
Indications :
B. Therapeutic
1. Removal of foreign bodies
2.
3.
Broncheoalveolar lavage
4.
5.
6.
RIGID BRONCHOSCOPY
Advantages :
1.
2.
RIGID BRONCHOSCOPY
Techniques Direct Insertion :
RIGID BRONCHOSCOPY
Techniques Direct Insertion :
RIGID BRONCHOSCOPY
Techniques Direct Insertion :
RIGID BRONCHOSCOPY
Techniques Direct Insertion :
RIGID BRONCHOSCOPY
Techniques Insertion Using a
Laryngoscope:
RIGID BRONCHOSCOPY
Techniques Insertion Using a
Laryngoscope:
FLEXIBLE BRONCHOSCOPY
Advantages :
1.
2.
3.
FLEXIBLE BRONCHOSCOPY
Complications :
1.
2.
3.
Laryngospasm
4.
Cardiac arrythmia
BRONCHOSCOPY
Normal Trachea
Inflamed Trachea
BRONCHOSCOPY
BRONCHOSCOPY
BRONCHOSCOPY
ESOPHAGOSCOPY
History :
Bozzini 1809
Kussmaul 1869
examined the esophagus using urethroscope
ESOPHAGOSCOPY
History :
Jackson 1900s
invented the first modern esophagoscope
1930s
the birth of fiberoptic illumination
1960s
ESOPHAGOSCOPY
Anatomy:
The esophagus is a tubular
structure about 10 inches or
25 cms.
start at the cricopharyngeus
and ends at the cardia
Cervical part is curved to the
left and the thoracic part is
curved to the right.
ESOPHAGOSCOPY
Anatomy - Constrictions:
1.
Cricopharyngeus
16 cms from the incisors
2.
3.
Gastroesophageal Junction
38 cms from the incisors
> Diaphragmatic constriction
ESOPHAGOSCOPY
Indications :
1.
2.
Surgical approach.
ESOPHAGOSCOPY
Rigid Esophagoscopy - Advantages :
1.
2.
3.
ESOPHAGOSCOPY
Flexible - Advantages :
1.
2.
3.
ESOPHAGOSCOPY
Instruments :
Rigid Bronchoscopes
Rigid Esophagoscopes
ESOPHAGOSCOPY
Technique
ESOPHAGOSCOPY
Complications :
1.
2.
3.
Dental trauma
4.
ESOPHAGOSCOPY
FOREIGN BODY
ESOPHAGOSCOPY
FOREIGN BODY
ESOPHAGOSCOPY
ESOPHAGEAL DISEASES
Esophageal varices
Esophageal cancer
END OF LECTURE