This document provides information about different laryngoscopy techniques. It begins with a brief history of laryngoscopy and then describes techniques such as indirect laryngoscopy using a mirror, direct laryngoscopy using a laryngoscope, and flexible and rigid fiber-optic laryngoscopy. Indirect laryngoscopy is described as the simplest examination method for visualizing the larynx and vocal cords. Flexible fiber-optic laryngoscopy allows for examination of the entire hypopharynx and larynx and is well-tolerated by patients. The document also covers laryngoscopy equipment, techniques, common mistakes, advantages and limitations of the different methods.
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Youtube:-https://www.youtube.com/watch?v=WHOggpW5Ee8
A Tracheostomy is a medical procedure either temporary or permanent that involves creating an opening in the neck in order to place a tube into a person's windpipe.
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Youtube:-https://www.youtube.com/watch?v=WHOggpW5Ee8
A Tracheostomy is a medical procedure either temporary or permanent that involves creating an opening in the neck in order to place a tube into a person's windpipe.
A brief awareness and knowledge about the insertion of NGT nasogastric Tube and feeding through it.
It contains an introduction, procedure, equipment needed, method of feeding etc
Bag and Mask Ventilation By Sakun Rasaily @Ram K Dhamalaramdhamala11
Bag and mask Ventilation Presented by Sakun Rasaily,
(Pediatric Nurse, Pediatric ward , B.P. Koirala Institute of Health Science
Dharan, Sunsari (Nepal)
We are having the broadest ranges of laryngoscopes available, including options to manage difficult airways, and improve procedural efficiency. For bulk orders feel free to visit our website.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
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Posterio anterior cephalometrics / dental implant courses by Indian dental ac...Indian dental academy
Description :
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
Postero - Anterior cephalometry basics/cosmetic dentistry coursesIndian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Postero anterior cephalometrics /certified fixed orthodontic courses by Indi...Indian dental academy
Description :
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
3. HISTORYHISTORY
18061806:: Bozzini (inventor of archetypal laryngoscope)Bozzini (inventor of archetypal laryngoscope)
18291829:: Babington (Glottiscope)Babington (Glottiscope)
18531853:: DesmoreauxDesmoreaux
18541854:: Manuel Garcia (“Autolaryngoscopy”)Manuel Garcia (“Autolaryngoscopy”)
18571857:: Czermak (head band mirror)Czermak (head band mirror)
Morell, Mackenzie, TurckMorell, Mackenzie, Turck
4. Early 1900Early 1900:: Chevalier JacksonChevalier Jackson
-use of magnification-use of magnification
-sniffing position-sniffing position
19411941:: RobertRobert MillerMiller
19431943 : Robert Macintosh: Robert Macintosh
19501950:: Operating microscopeOperating microscope
19601960:: Hopkins (rod lens telescope)Hopkins (rod lens telescope)
Late 1960Late 1960:: Jako & Kleinsasser (fiberoptic laryngoscopeJako & Kleinsasser (fiberoptic laryngoscope
used with operating microscope)used with operating microscope)
6. Indications for LaryngoscopyIndications for Laryngoscopy
Diagnostic:Diagnostic:
1.Hoarseness 10.Shortness of breath1.Hoarseness 10.Shortness of breath
2.Voice changes 11.Dysarthria2.Voice changes 11.Dysarthria
3.Chronic cough 12.Stridor3.Chronic cough 12.Stridor
4.Choking episodes 13.Suspicion of laryngeal4.Choking episodes 13.Suspicion of laryngeal
5.Odynophagia/Dysphagia foreign body5.Odynophagia/Dysphagia foreign body
6.Chronic throat pain 14.Suspicion of carcinoma6.Chronic throat pain 14.Suspicion of carcinoma
7.Globus sensation (Biopsy)7.Globus sensation (Biopsy)
8.Hemoptysis 15.Dyspnea8.Hemoptysis 15.Dyspnea
9.Referred otalgia9.Referred otalgia
7. Therapeutic:Therapeutic:
11.Intubation.Intubation
2.Foreign body removal2.Foreign body removal
3.Biopsy of a growth in hypopharynx or vocal cords3.Biopsy of a growth in hypopharynx or vocal cords
4.Treatment for benign & malignant diseases: eg Laser4.Treatment for benign & malignant diseases: eg Laser
therapy, Microlaryngeal Surgerytherapy, Microlaryngeal Surgery
5.Placing gastric tube, Transesophageal echocardiac probe5.Placing gastric tube, Transesophageal echocardiac probe
8. Indirect LaryngoscopyIndirect Laryngoscopy
Simplest method of larynx & vocal cord examinationSimplest method of larynx & vocal cord examination
Most adults and older childrenMost adults and older children
Significant skill & patient co-operationSignificant skill & patient co-operation
Examination of Oropharynx, hypopharynx & LarynxExamination of Oropharynx, hypopharynx & Larynx
Larynx examination:Larynx examination:
1.At rest1.At rest
2.Gentle breathing2.Gentle breathing
3.During phonation3.During phonation
4.Coughing4.Coughing
10. Technique :Technique :
1.Explain the procedure1.Explain the procedure
2.Sitting position2.Sitting position
3.Open mouth : topical anesthesia3.Open mouth : topical anesthesia
4.Placement of laryngeal mirror: defogging agent4.Placement of laryngeal mirror: defogging agent
5.Reverse image5.Reverse image
Inspecting areas in an orderInspecting areas in an order
11.
12. Structure to be examined:Structure to be examined:
1.Base of the tongue 11.Ventricles1.Base of the tongue 11.Ventricles
2.Vallecula 12.Anterior commissure2.Vallecula 12.Anterior commissure
3.Median glossoepiglottic fold 13.Posterior wall of3.Median glossoepiglottic fold 13.Posterior wall of
4.Pharyngoepiglottic folds larynx4.Pharyngoepiglottic folds larynx
5.Lateral pharyngeal wall 14.Upper 2 or 35.Lateral pharyngeal wall 14.Upper 2 or 3
6.Epiglottis(both surfaces) tracheal rings6.Epiglottis(both surfaces) tracheal rings
7.Arytenoids 15.Pyriform Fossa7.Arytenoids 15.Pyriform Fossa
8.Aryepiglottic folds8.Aryepiglottic folds
9.False cords9.False cords
10.True cords10.True cords
13. Details of symmetry, motion, surface architecture,Details of symmetry, motion, surface architecture,
evidence of inflammation & abnormal masses or growthevidence of inflammation & abnormal masses or growth
Pooling of saliva in PFS: 1.poor laryngeal sensationPooling of saliva in PFS: 1.poor laryngeal sensation
2.weak lateral pharyngeal wall 3.inefficient swallow2.weak lateral pharyngeal wall 3.inefficient swallow
eg. growth or foreign body in postcricoid region or uppereg. growth or foreign body in postcricoid region or upper
esophagusesophagus
Mobility of the vocal cords:Mobility of the vocal cords:
““eeh” or “aah”eeh” or “aah”
Glottic chinkGlottic chink
14. Most Common MistakesMost Common Mistakes
1.Procedure explanation1.Procedure explanation
2.Patient’s position2.Patient’s position
3.Focus light on mirror3.Focus light on mirror
4.Lifting uvula4.Lifting uvula
5.Visualising larynx directly without looking at adjacent5.Visualising larynx directly without looking at adjacent
structuresstructures
6.Recording side of lesion6.Recording side of lesion
16. Limitations of I/L Examination:Limitations of I/L Examination:
Uncontrollable gag reflexUncontrollable gag reflexApprox.10% patients I/L isApprox.10% patients I/L is
not possiblenot possible
Anatomic variations eg. large tongue, micrognathia andAnatomic variations eg. large tongue, micrognathia and
trismustrismus
Entire PFS (esp.apex) & Postcricoid region cant be seenEntire PFS (esp.apex) & Postcricoid region cant be seen
Perceptual errorPerceptual error
17. Killian’s ModificationKillian’s Modification: standing position of examiner: standing position of examiner
with vertical and parallel placement of mirror towith vertical and parallel placement of mirror to
posterior part of pharynx- for anterior commissureposterior part of pharynx- for anterior commissure
19. Flexible Nasopharyngolaryngoscopy(NPL)Flexible Nasopharyngolaryngoscopy(NPL)
--Indications:Indications:
-Young children-Young children
-Difficult cases for IL exam: eg. Pts with excessive gags-Difficult cases for IL exam: eg. Pts with excessive gags
-Neurological problems or Anatomical abnormalities:-Neurological problems or Anatomical abnormalities:
micrognathia, cervical spine rigidity, instability ormicrognathia, cervical spine rigidity, instability or
immobility of TMJimmobility of TMJ
-Proper assessment of any condition in hypopharynx and-Proper assessment of any condition in hypopharynx and
larynxlarynx
-Teaching purpose-Teaching purpose
-Photography & Video documentation-Photography & Video documentation
20. Longer interval for the hypopharynx & larynxLonger interval for the hypopharynx & larynx
examinationexamination
(Apex of PFS: on Valsalva Maneuver)(Apex of PFS: on Valsalva Maneuver)
Fiberoptic telescopes with outer diameter as narrow asFiberoptic telescopes with outer diameter as narrow as
2.2mm2.2mm atraumatic passage through nares inatraumatic passage through nares in
neonateneonate
--Smaller telescopes --- more comfortableSmaller telescopes --- more comfortable
--Larger telescopes --- better quality imageLarger telescopes --- better quality image
22. Specific work upSpecific work up
Routine Head & Neck Examination:Routine Head & Neck Examination:
- Nasal Patency- Nasal Patency
- Indirect Laryngoscopy- Indirect Laryngoscopy
23. EquipmentEquipment
1.Short cable endoscope1.Short cable endoscope: eg.: eg. Machida scopeMachida scope
Advantages:Advantages:
-Low cost-Low cost
-Adequate optical characteristics-Adequate optical characteristics
-Light weight, short cable-Light weight, short cable easy for routine basiseasy for routine basis
Disadvantages:Disadvantages:
-Lack of suctioning capability-Lack of suctioning capability
-Precludes examination of subglottis & trachea-Precludes examination of subglottis & trachea
24. 2.Long cable endoscope:2.Long cable endoscope: eg.eg. Olympus BronchofiberscopeOlympus Bronchofiberscope
AdvantagesAdvantages
-Second port: instillation of topical anesthetics, continuous-Second port: instillation of topical anesthetics, continuous
suctioning & biopsysuctioning & biopsy
-Evaluation of tracheobronchial tree-Evaluation of tracheobronchial tree
DisadvantagesDisadvantages
-High cost-High cost
-Extra length-Extra length
25. Flexible Fiberoptic LaryngoscopeFlexible Fiberoptic Laryngoscope Light -separate source.Light -separate source.
The lever on the handle - deflection of the tip in twoThe lever on the handle - deflection of the tip in two
directions. Two ports- insufflation and suctioningdirections. Two ports- insufflation and suctioning
26.
27.
28. AdvantagesAdvantages
1.Well tolerated :OPD or bed side1.Well tolerated :OPD or bed side
sitting erect, supine positionsitting erect, supine position
2.Not limited by fixation of spine or mandible2.Not limited by fixation of spine or mandible
3.Low chance of injury eg. teeth, mucosa3.Low chance of injury eg. teeth, mucosa
4.Excellent evaluation of larynx & tracheobronchial tree4.Excellent evaluation of larynx & tracheobronchial tree
5.Teaching sidearm5.Teaching sidearm
6.Suction & biopsy capability(olympus type)6.Suction & biopsy capability(olympus type)
7.Photography7.Photography
31. Bite block :kept between teeth to prevent damage to aBite block :kept between teeth to prevent damage to a
fiberoptic endoscopefiberoptic endoscope
32. Local anesthesiaLocal anesthesia: pt comfort & co-operation, ameliorate: pt comfort & co-operation, ameliorate
reflex response (tachycardia, HTN, laryngospasm)reflex response (tachycardia, HTN, laryngospasm)
Topical anesthesiaTopical anesthesia Palate & PPWPalate & PPW
Precaution: pt shouldn’t eat or drink until adequatePrecaution: pt shouldn’t eat or drink until adequate
laryngeal sensation returnslaryngeal sensation returns
Topical decongestantsTopical decongestants: to decrease nasal mucosal: to decrease nasal mucosal
edema, congestion or secretionsedema, congestion or secretions
Precaution : hyperthyroidism, cardiovascular disease,Precaution : hyperthyroidism, cardiovascular disease,
HTN,DM, BPH, narrow angle glaucomaHTN,DM, BPH, narrow angle glaucoma
33. SterilisationSterilisation
Glutaraldehyde soaking: damage endoscopeGlutaraldehyde soaking: damage endoscope
ineffectiveineffective
staff health concernstaff health concern
Ethylene oxide: very effective but requires 24 hrs to workEthylene oxide: very effective but requires 24 hrs to work
Wiping with swab : mayn’t prevent against infectiousWiping with swab : mayn’t prevent against infectious
diseases eg. Tuberculosisdiseases eg. Tuberculosis
Better options:Better options:
1.Have more than one endoscope available in ENT department1.Have more than one endoscope available in ENT department
2.Protective disposable sheaths2.Protective disposable sheathspreferred methodpreferred method
3.Daily high level of disinfection of the endoscopes3.Daily high level of disinfection of the endoscopes
34. Rigid Fiberoptic EndoscopyRigid Fiberoptic Endoscopy
OPDOPD
Adults & in children as young as 6 -8 yrsAdults & in children as young as 6 -8 yrs
Position & technique for inserting :similar to mirror examPosition & technique for inserting :similar to mirror exam
Rigid telescope :angled lens 0 * or 90 * Hopkins rodRigid telescope :angled lens 0 * or 90 * Hopkins rod
eg. storz rigid fiberoptic systemeg. storz rigid fiberoptic system
Image, size & clarity better than flexible fiberoptic systemImage, size & clarity better than flexible fiberoptic system
38. ComplicationsComplications
1.Damage to teeth and pharyngeal mucosa1.Damage to teeth and pharyngeal mucosa
2.Evolving airway problems2.Evolving airway problems laryngeallaryngeal
spasmspasm
39. Direct LaryngoscopyDirect Laryngoscopy
Direct visualisation of larynx & hypopharynxDirect visualisation of larynx & hypopharynx
Range from simple rigid scopes with a light bulb toRange from simple rigid scopes with a light bulb to
complex fiberoptic video devicescomplex fiberoptic video devices
Rigid laryngoscopes manufactured - single-piece or aRigid laryngoscopes manufactured - single-piece or a
separate detachable blade with light source & handleseparate detachable blade with light source & handle
40. For a detachable handle and blade- light source isFor a detachable handle and blade- light source is
energized when the blade and handle are locked inenergized when the blade and handle are locked in
the operating positionthe operating position
A hook-on connection between the handle and bladeA hook-on connection between the handle and blade
is most commonly usedis most commonly used
41. Many blade typesMany blade types::
Macintosh blade-Macintosh blade- curved blade, sits anterior to epiglottiscurved blade, sits anterior to epiglottis
Miller blade-Miller blade- straight blade, sits posterior to epiglottisstraight blade, sits posterior to epiglottis
usually for infants-larger comparative size of epiglottis,usually for infants-larger comparative size of epiglottis,
Macintosh less effectiveMacintosh less effective
45. Handle:Handle:
– It provides the power for the lightIt provides the power for the light
– Most often, disposable batteries are the powerMost often, disposable batteries are the power
sourcesource
– Fiberoptic-illuminated laryngoscopes may use aFiberoptic-illuminated laryngoscopes may use a
remote electrically operated light sourceremote electrically operated light source
47. – Most blades form a right angle with the handle whenMost blades form a right angle with the handle when
ready for use, the angle may also be acute or obtuseready for use, the angle may also be acute or obtuse
– Patil-Syracuse handle can be positioned and lockedPatil-Syracuse handle can be positioned and locked
in four different positionsin four different positions
48. Patil-Syracuse handle. With this handle, the blade can be adjusted andPatil-Syracuse handle. With this handle, the blade can be adjusted and
locked in four different positions (45°, 90°,135° or 180°)locked in four different positions (45°, 90°,135° or 180°)
49. BladeBlade
– Blades are available in more than one sizeBlades are available in more than one size
– Numbered, with the number increasing with sizeNumbered, with the number increasing with size
SizeSize Intended UseIntended Use
000000 Small premature infantSmall premature infant
0000 Premature infantPremature infant
00 NeonateNeonate
11 Small ChildSmall Child
22 ChildChild
33 AdultAdult
44 Large AdultLarge Adult
55 Extra Large AdultExtra Large Adult
51. – Parts of bladeParts of blade::
BaseBase - part that attaches to the handle, has a slot- part that attaches to the handle, has a slot
for engaging the hinge pin of the handlefor engaging the hinge pin of the handle
HeelHeel - end of the base- end of the base
TongueTongue (spatula)(spatula)
– Main shaftMain shaft
– Compress and manipulate the soft tissuesCompress and manipulate the soft tissues
(especially the tongue) and lower jaw(especially the tongue) and lower jaw
– Blades referred to as curved or straight,Blades referred to as curved or straight,
depending on shape the tonguedepending on shape the tongue
– Generally- straight blades provide betterGenerally- straight blades provide better
laryngeal visualization, curved blades makelaryngeal visualization, curved blades make
intubation easierintubation easier
52. FlangeFlange
– Projects off the side of the tongueProjects off the side of the tongue
– Serves to guide instrumentation & deflectServes to guide instrumentation & deflect
tissues from the line of visiontissues from the line of vision
– Determines the cross-sectional shape of theDetermines the cross-sectional shape of the
bladeblade
TipTip
– Contacts either the epiglottis or vallecula &Contacts either the epiglottis or vallecula &
directly or indirectly elevates the epiglottisdirectly or indirectly elevates the epiglottis
– Usually blunt and thickened to decrease traumaUsually blunt and thickened to decrease trauma
53. Light source:Light source:
-- Lamp (bulb) or fiberoptic bundle that transmitsLamp (bulb) or fiberoptic bundle that transmits
light from a source in handlelight from a source in handle
– Fiberoptic-illuminated blade has an encasedFiberoptic-illuminated blade has an encased
fiberoptic bundle - transmits light from sourcefiberoptic bundle - transmits light from source
in the handle or base of bladein the handle or base of blade
– Because there is no bulb or electrical contact inBecause there is no bulb or electrical contact in
the blade, cleaning and sterilization are easierthe blade, cleaning and sterilization are easier
– Fiberoptic-illuminated blades to have a greenFiberoptic-illuminated blades to have a green
mark on the heel.mark on the heel.
54. Macintosh BladeMacintosh Blade
– One of the most commonly used bladesOne of the most commonly used blades
– Tongue is curvedTongue is curved
– In cross section, the tongue, web, and flangeIn cross section, the tongue, web, and flange
form a reverse Zform a reverse Z
– Cervical spine movement is greater with theCervical spine movement is greater with the
Macintosh blade compared with the Miller bladeMacintosh blade compared with the Miller blade
55.
56.
57. Miller Blade:Miller Blade:
– Tongue is straight with a slightTongue is straight with a slight
upward curve near the tipupward curve near the tip
– In cross section, the flange,In cross section, the flange,
web, and tongue form a C withweb, and tongue form a C with
the top fattenedthe top fattened
58. Mallampati ClassificationMallampati Classification
Class IClass I-soft palate, fauces, uvula, tonsillar-soft palate, fauces, uvula, tonsillar
pillars visiblepillars visible
Class IIClass II-soft palate, fauces, uvula visible-soft palate, fauces, uvula visible
Class IIIClass III-soft palate, base of uvula visible-soft palate, base of uvula visible
Class IVClass IV-soft palate not visible-soft palate not visible
62. Indications:Indications:
Diagnostic:Diagnostic:
1.When I/L not possible eg. young children, excessive gags,1.When I/L not possible eg. young children, excessive gags,
overhanging epiglottisoverhanging epiglottis
2.Hidden areas:2.Hidden areas:
Hypopharynx: base of tongue, vallecula, apex of PFSHypopharynx: base of tongue, vallecula, apex of PFS
Larynx: infrahyoid epiglottis, anterior commissure, ventriclesLarynx: infrahyoid epiglottis, anterior commissure, ventricles
& subglottic region& subglottic region
3.Extent of growth & biopsy3.Extent of growth & biopsy
63. Therapeutic:Therapeutic:
1.Removal of benign lesions of larynx1.Removal of benign lesions of larynx
2.Removal of foreign body from hypopharynx & larynx2.Removal of foreign body from hypopharynx & larynx
65. ProcedureProcedure :-:-
Position: sniffing positionPosition: sniffing position
Anaesthesia: GA /LAAnaesthesia: GA /LA
Procedure :Procedure :
-eye cover, dental protection ,drapping-eye cover, dental protection ,drapping
-widest scope (different scope to visualise different subsites-widest scope (different scope to visualise different subsites
of endolarynx)of endolarynx)
66. Head reachingHead reaching
proximal edge of tableproximal edge of table
The “sniffer” or Boyce-The “sniffer” or Boyce-
Jackson positionJackson position
provides the bestprovides the best
visualization of thevisualization of the
larynxlarynx
Neck flexed onNeck flexed on
shoulders & headshoulders & head
extended on neckextended on neck
72. ComplicationsComplications
1.Injury to lip, teeth & tongue1.Injury to lip, teeth & tongue
2.Bleeding2.Bleeding
3.Laryngeal edema3.Laryngeal edema
4.Cervical spinal cord injury4.Cervical spinal cord injury
5.Swallowing or aspirating foreign body5.Swallowing or aspirating foreign body
73. Differences between I/L and D/LDifferences between I/L and D/L
I/LI/L D/LD/L
Foreshortening of AP diameterForeshortening of AP diameter No foreshorteningNo foreshortening
True & false cord appear to be inTrue & false cord appear to be in
contact with each othercontact with each other
Separated by ventriclesSeparated by ventricles
Inverted mirror imageInverted mirror image Direct visualisationDirect visualisation
Movement of cords seen betterMovement of cords seen better Seen only in LASeen only in LA
Under surface is not seenUnder surface is not seen Some idea is gainedSome idea is gained
Ventricles not seenVentricles not seen Seen by pressing the falseSeen by pressing the false
cordscords
OPD procedureOPD procedure Done in O TDone in O T
75. Bullard LaryngoscopeBullard Laryngoscope
A rigid fiber-optic laryngoscopeA rigid fiber-optic laryngoscope
specially shaped to follow thespecially shaped to follow the
contour of oropharynxcontour of oropharynx
Working channel- suction, oxygenWorking channel- suction, oxygen
insufflation, LA or administrationinsufflation, LA or administration
Available in three sizes : pediatric,Available in three sizes : pediatric,
pediatric long, and adultpediatric long, and adult
76. Advantages of Bullard LaryngoscopeAdvantages of Bullard Laryngoscope
Useful during difficult intubationUseful during difficult intubation
In neutral position. eg.unstable cervical spine, TMJIn neutral position. eg.unstable cervical spine, TMJ
immobility, micrognathiaimmobility, micrognathia
Patients with mouth opening of just 6 mmPatients with mouth opening of just 6 mm
Safely used in pediatric population eg.anteriorly placedSafely used in pediatric population eg.anteriorly placed
larynxlarynx
77. MicrolaryngoscopyMicrolaryngoscopy
Prof.Prof. Rosemarie AlbrechtRosemarie Albrecht - Germany (1954)- Germany (1954)
first microscopic visualization ofthe Vocal Foldsfirst microscopic visualization ofthe Vocal Folds
Prof.Prof. Oskar KleinsassarOskar Kleinsassar - Germany (1962)- Germany (1962)
- modern state of the art method of microlaryngosurgery- modern state of the art method of microlaryngosurgery
Dr.Dr. Geza Jako –Geza Jako – USA (1962)USA (1962) designed a series of microlaryngealdesigned a series of microlaryngeal
instrumentsinstruments
78. Standard procedure for Endolaryngeal SurgeryStandard procedure for Endolaryngeal Surgery
Advantages:Advantages:
1.Binocular vision1.Binocular vision
2.Bimanual handling2.Bimanual handling
3.High resolution magnification3.High resolution magnification
Disadvantages:Disadvantages:
Considerable force to bring oropharyngeal structure inConsiderable force to bring oropharyngeal structure in
midlinemidline tissue injurytissue injury
79. Largest-caliber laryngoscopeLargest-caliber laryngoscope
Not a single “best” oneNot a single “best” one
that fits all situationsthat fits all situations
Contact area -upper teethContact area -upper teeth
- flat- flat
Anatomical configuration easesAnatomical configuration eases
exposure ant commissureexposure ant commissure
82. Advantages of Microlaryngoscopy over DirectAdvantages of Microlaryngoscopy over Direct
Laryngoscopy:Laryngoscopy:
- Binocular vision- Binocular vision
- MagnificationMagnification
- Better illuminationBetter illumination
- Bimanual handlingBimanual handling
- Ability to use CO2 laserAbility to use CO2 laser
83. Contact EndoscopyContact Endoscopy
New phase in the development of endoscopyNew phase in the development of endoscopy
Commonly used in researchCommonly used in research
In 1865- DesmoreauxIn 1865- Desmoreaux
JaupitreJaupitre
HamouHamou
84. In vivo & in situ assessment of mucosa and underlying microvascularIn vivo & in situ assessment of mucosa and underlying microvascular
networknetwork
Topical anesthesia or GATopical anesthesia or GA
Oral cavity, oropharynx, nasal cavity, nasopharynx, hypopharynx &Oral cavity, oropharynx, nasal cavity, nasopharynx, hypopharynx &
larynxlarynx
Simple ,non invasive techniqueSimple ,non invasive technique
Earlier subclinical stages of disease, Dx of early cancer, tumor margins,Earlier subclinical stages of disease, Dx of early cancer, tumor margins,
select area for biopsy, assessment of the response to therapyselect area for biopsy, assessment of the response to therapy
(radiotherapy/chemotherapy), F/U of cancer pts(radiotherapy/chemotherapy), F/U of cancer pts
85. Contact Endoscopy of LarynxContact Endoscopy of Larynx
-GA-GA
-Microlaryngoscopy-Microlaryngoscopy
-Commonly used two endoscopes:-Commonly used two endoscopes:
7215 AA,7215 BA Karl Storz7215 AA,7215 BA Karl Storz
-Surface epithelium and subsurface microvascular-Surface epithelium and subsurface microvascular
plexusplexus
-Magnification x60 and x150-Magnification x60 and x150
86. Mucosal surface-cleaned by suction or saline swabMucosal surface-cleaned by suction or saline swab
Staining-1% methylene blueStaining-1% methylene blue
Normal & abnormal appearanceNormal & abnormal appearance
Cellular & nuclear morphology( shape, size, staining etc)Cellular & nuclear morphology( shape, size, staining etc)
Microvasculature pattern & architecture-vessels ofMicrovasculature pattern & architecture-vessels of
varying size, thrombosis, ectasia, rupturevarying size, thrombosis, ectasia, rupture
87.
88.
89. StroboscopyStroboscopy
Special method to visualize vocal fold vibrationSpecial method to visualize vocal fold vibration
-In-In 18781878-Oertel first performed Stroboscopy-Oertel first performed Stroboscopy
-In early to mid-In early to mid 19001900-Plateau-Plateau
-In-In 19601960-Vanden Berg, Rolf Timke (book on-Vanden Berg, Rolf Timke (book on
stroboscopic examination of larynx)stroboscopic examination of larynx)
90. Vocal fold vibration is fast(100 cycles/sec)Vocal fold vibration is fast(100 cycles/sec)
Ability of retina to process individualAbility of retina to process individual
images(5 images/sec)images(5 images/sec)
Synchronized flashing light through rigidSynchronized flashing light through rigid
or flexible telescope at a slightly sloweror flexible telescope at a slightly slower
speedspeed illusion of slow vocal foldillusion of slow vocal fold
vibrationvibration
Slow motion view derived from manySlow motion view derived from many
successive vibration cyclessuccessive vibration cycles
91. Allows evaluation of vocal fold vibration properties duringAllows evaluation of vocal fold vibration properties during
different phases of vibration cycle (adduction,different phases of vibration cycle (adduction,
aerodynamic separation & recoil)aerodynamic separation & recoil)
Parameters – symmetry, amplitude, speed and phaseParameters – symmetry, amplitude, speed and phase
differences of waves on two cordsdifferences of waves on two cords
Vibrating part of vocal fold sharply defined, & anythingVibrating part of vocal fold sharply defined, & anything
protruding from medial surface observedprotruding from medial surface observed
Extremely fast vibratory motionExtremely fast vibratory motion gentle waving motiongentle waving motion
92. Valuable in assessing : functional & anatomical defectsValuable in assessing : functional & anatomical defects
1.Stiffness1.Stiffness
2.Scar2.Scar
3.Submucosal injury3.Submucosal injury
4.Small vocal cord lesions eg. nodule, polyp, cyst4.Small vocal cord lesions eg. nodule, polyp, cyst
5.Estimating depth of invasion of a tumor & early detection5.Estimating depth of invasion of a tumor & early detection
of glottic cancerof glottic cancer
6.Identifying asymmetric mass or tension6.Identifying asymmetric mass or tension
7.Determining resumption of voicing activities after7.Determining resumption of voicing activities after
phonosurgeryphonosurgery