diagnostic endoscopy of the larynx, bronchus,1
DESCRIPTION
DIAGNOSTIC ENDOSCOPY OF THE LARYNX, BRONCHUSTRANSCRIPT
DIAGNOSTIC ENDOSCOPY OF THE LARYNX, BRONCHUS,
AND ESOPHAGUS
Julie G. Cebrian, MD, FPSO-HNS
Introduction1.Laryngoscopy a. Indirect b. Direct
2. Bronchoscopy a. Rigid b. Flexible
3. Esophagoscopy a. Rigid b. Flexible
LaryngoscopyHistory :History :
• Manuel Garcia – 1830sManuel Garcia – 1830s - first to successfully visualize the larynx using dental mirror and sunlight
• Late 1800s – Mckenzie, JacksonLate 1800s – Mckenzie, Jackson and Hollinger and Hollinger
- design and modification of the rigid endoscopes
LaryngoscopyHistory :History :
• 1930s1930s advent of fiber optic illumination
• 1960s1960s flexible endoscopes
• 1970s1970s stroboscopic techniques
INDIRECT MIRROR Laryngoscopy
Probably the most important outpatientProbably the most important outpatient diagnostic procedure for examining the larynxdiagnostic procedure for examining the larynx
Its biggest drawback is a tendency to cause Its biggest drawback is a tendency to cause gagging in some patientsgagging in some patients
It may also not adequately allow for It may also not adequately allow for visualization of the anterior commissurevisualization of the anterior commissure
INDIRECT MIRROR Laryngoscopy
IndicationsIndications::
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
EquipmentEquipment::
1. Laryngeal Mirror
2. Head mirror with light source
3. Gauze
INDIRECT MIRROR Laryngoscopy
TechniqueTechnique::
DIRECT Laryngoscopy
I.I. Direct Flexible LaryngoscopyDirect Flexible Laryngoscopy
II.II. VideolaryngoscopyVideolaryngoscopy
III.III. Direct Rigid LaryngoscopyDirect Rigid Laryngoscopy
DIRECT Laryngoscopy
Performed under local Performed under local anesthesiaanesthesia
Excellent for evaluating larynxExcellent for evaluating larynx of trauma patient with of trauma patient with suspected cervical fracturesuspected cervical fracture
Can be used to evaluate Can be used to evaluate trachea and bronchi amongtrachea and bronchi among laryngectomized patientslaryngectomized patients
I. Flexible Fiberoptic Laryngoscopy
DIRECT LaryngoscopyI. Flexible Fiberoptic Laryngoscopy
DIRECT Laryngoscopy
Equipment:
1. Laryngeal endoscope 70° and 90°
2. Video camera
3. Video adapter
4. Light source and cable
5. Video recorder and monitor
II. Videolaryngoscopy
DIRECT Laryngoscopy
TechniqueTechnique::
II. Videolaryngoscopy
DIRECT Laryngoscopy
Advantage over Flexible LaryngoscopyAdvantage 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
II. Videolaryngoscopy
DIRECT Laryngoscopy
1.1. Staging and biopsy of laryngopharyngeal Staging and biopsy of laryngopharyngeal lesions.lesions.
3. For patients in whom flexible laryngoscopy is3. For patients in whom flexible laryngoscopy is not possiblenot possible
2. Rule out a second primary tumor or as a part2. Rule out a second primary tumor or as a part of the work-up of metastatic tumors of un-of the work-up of metastatic tumors of un- known originknown origin
IndicationsIndications::III. Direct Rigid Laryngoscopy
DIRECT Laryngoscopy
4. Patients presenting with displaced or open 4. Patients presenting with displaced or open laryngeal fracturelaryngeal fracture
5. Provides surgical approach 5. Provides surgical approach
IndicationsIndications::
III. Direct Rigid Laryngoscopy
DIRECT Laryngoscopy
InstrumentsInstruments::
III. Direct Rigid Laryngoscopy
DIRECT Laryngoscopy
TechniqueTechnique::
III. Direct Rigid Laryngoscopy
DIRECT Laryngoscopy
TechniqueTechnique::
III. Direct Rigid Laryngoscopy
DIRECT Laryngoscopy
ComplicationsComplications::
1. Laryngeal edema1. Laryngeal edema
2. Bleeding2. Bleeding
3. Airway compromise3. Airway compromise
4. Tooth fracture / avulsion4. Tooth fracture / avulsion
III. Direct Rigid Laryngoscopy
Direct laryngoscopyFOREIGN BODYFOREIGN BODY
Dentures in the right pyriform sinus
Direct laryngoscopyFOREIGN BODYFOREIGN BODY
Fishbone stuck in the left pyriform sinus 3 cm fishbone
BRONCHOSCOPYBronchoscopic Anatomy:Bronchoscopic Anatomy: Trachea begins immediately
inferior to cricoid cartilageHollow tube 5 inches or 13 cms long
Supported by U-shaped bars of hyaline cartilages
Divides into 2 main bronchi at the carina
BRONCHOSCOPYBronchoscopic Anatomy:Bronchoscopic Anatomy:
Principal Bronchi 1. Right
Wider Shorter (1 inch ) More vertical
2. Left Narrower Longer (2 inches) More horizontal
BRONCHOSCOPYBronchoscopic Anatomy:Bronchoscopic Anatomy:
Secondary Bronchi Lobar bronchus
Tertiary Bronchi Segmental Bronchi Gives rise to the
bronchopulmonary segments
BRONCHOSCOPYBronchoscopic Anatomy:Bronchoscopic Anatomy:
The distance from the cricoid to the carina is 10 cms
The lung is divided into 3 lobes on the right and 2 lobes on the left.
There are a total of 18 bronchopulmonary segments.
BRONCHOSCOPYHistory :History :
• Gustave Killian – 1897Gustave Killian – 1897
first translaryngeal examination of the trachea
• Early 1900s – JacksonEarly 1900s – Jackson fully developed the art of bronchoscopy
reported the removal of a foreign body from bronchus
BRONCHOSCOPYHistory :History :
• Ikeda and associates – 1968Ikeda and associates – 1968
reported the development of flexible bronchoscope
Flexible Bronchoscope
BRONCHOSCOPYEquipment Equipment ::
Rigid Bronchoscopes
BRONCHOSCOPYIndicationsIndications : :
A. Diagnostic
1.1. HemoptysisHemoptysis2.2. Mass lesion on radiographMass lesion on radiograph3.3. Transbronchial biopsyTransbronchial biopsy4.4. Infectious processInfectious process5.5. Search for second primary malignancySearch for second primary malignancy6.6. Evaluate tracheal/bronchial stenosisEvaluate tracheal/bronchial stenosis
BRONCHOSCOPYIndicationsIndications : :
B. Therapeutic
1. Removal of foreign bodies
2. Suction of inspissated mucus
3. Broncheoalveolar lavage
4. Transbronchial drainage of abscess
5. Removal of obstructing lesion
6. Dilatation/resection of cicatricial scar
RIGID BRONCHOSCOPYAdvantagesAdvantages : :
1. Provides more secure control of the airway and permits ventilatory support.
2. Allows insertion of larger working instrument and suction tubes.
RIGID BRONCHOSCOPYTechniques – Direct InsertionTechniques – Direct Insertion : :
RIGID BRONCHOSCOPYTechniques – Direct InsertionTechniques – Direct Insertion : :
RIGID BRONCHOSCOPYTechniques – Direct InsertionTechniques – Direct Insertion : :
RIGID BRONCHOSCOPYTechniques – Direct InsertionTechniques – Direct Insertion : :
RIGID BRONCHOSCOPYTechniques – Insertion Using a Techniques – Insertion Using a LaryngoscopeLaryngoscope::
RIGID BRONCHOSCOPYTechniques – Insertion Using a Techniques – Insertion Using a LaryngoscopeLaryngoscope::
FLEXIBLE BRONCHOSCOPYAdvantagesAdvantages : :
1. Ability to visualize the subsegmental bronchi
2. Allows the bronchoscopist to obtain selective biopsies including brush type
3. May be done under local anesthesia
FLEXIBLE BRONCHOSCOPYComplicationsComplications : :
1. Hemorrhage from blind biopsies
2. Hypoxia, anoxia, and respiratory arrest
3. Laryngospasm
4. Cardiac arrythmia
BRONCHOSCOPY
Normal Trachea Inflamed Trachea
BRONCHOSCOPY
Mucus Plug in Trachea
BRONCHOSCOPY
Tumor eroding the right main bronchus
Extensive tumor of the right main bronchus
BRONCHOSCOPY
Peanut found in the right secondary bronchus
ESOPHAGOSCOPYHistory :History :
• Bozzini – 1809Bozzini – 1809 attempted to examine the upper esophagus using mirror
• Kussmaul – 1869 Kussmaul – 1869 examined the esophagus using urethroscope described the proper head position to pass the endoscope
ESOPHAGOSCOPYHistory :History :
• Jackson – 1900sJackson – 1900s invented the first modern esophagoscope
• 1930s 1930s the birth of fiberoptic illumination
• 1960s 1960s introduction of flexible endoscopes
ESOPHAGOSCOPYAnatomyAnatomy::
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.
ESOPHAGOSCOPYAnatomy - ConstrictionsAnatomy - Constrictions::
1. Cricopharyngeus 16 cms from the incisors
2. Left main Stem Bronchus 27 cms from the incisors > Aortic constriction
3. Gastroesophageal Junction 38 cms from the incisors > Diaphragmatic constriction
ESOPHAGOSCOPYIndicationsIndications : :
1.1. Diagnostic tool for evaluation of suspected Diagnostic tool for evaluation of suspected
tumors, trauma, strictures, benign tumors, trauma, strictures, benign
inflammatory condition.inflammatory condition.
2.2. Surgical approach.Surgical approach.
ESOPHAGOSCOPYRigid Esophagoscopy - AdvantagesRigid Esophagoscopy - Advantages : :
1.1. Evaluates the cervical esophagusEvaluates the cervical esophagus
2.2. Allows the use of larger cannula and surgical Allows the use of larger cannula and surgical
instrumentsinstruments
3.3. Allows manipulation and removal of foreign Allows manipulation and removal of foreign
bodies and stricture dilatationbodies and stricture dilatation
ESOPHAGOSCOPYFlexible - AdvantagesFlexible - Advantages : :
1.1. Improves visualization of the gastroesophageal Improves visualization of the gastroesophageal
junctionjunction
2.2. Allows instrumentation in patients with severe Allows instrumentation in patients with severe limitation of the range of motion of the necklimitation of the range of motion of the neck
3.3. Done under local anesthesia with sedationDone under local anesthesia with sedation
ESOPHAGOSCOPYInstrumentsInstruments : :
Rigid Bronchoscopes
Rigid Esophagoscopes
ESOPHAGOSCOPYTechniqueTechnique
ESOPHAGOSCOPYComplicationsComplications : :
1.1. Injury to upper aerodigestive tractInjury to upper aerodigestive tract
2.2. Aspiration of esophagogastric fluid, oral Aspiration of esophagogastric fluid, oral secretions, and bloodsecretions, and blood
3.3. Dental traumaDental trauma
4.4. Arrythmia or changes in blood pressureArrythmia or changes in blood pressure
ESOPHAGOSCOPYFOREIGN BODYFOREIGN BODY
COIN – most common foreign body seen ingested by children
ESOPHAGOSCOPYFOREIGN BODYFOREIGN BODY
Mouse trapped in the esophagus
ESOPHAGOSCOPYESOPHAGEAL DISEASESESOPHAGEAL DISEASES
Esophageal varices Esophageal cancer
END OF LECTURE