Introduction
Laryngoscopy is the gold standard for the assessment of the larynx while
preserving airway, speech and swallowing ability. Direct and
micro-laryngoscopy are performed to diagnose, stage and treat lesions of
the hypopharynx and larynx for benign and malignant lesions and for
phono-microsurgery (1).
Good exposure, visualisation and access of the larynx are essential for
the procedure. In some patients it can be difficult to visualise and
access the whole larynx. In this situation, inadequate laryngeal
exposure could result in misdiagnosis, incomplete removal of lesions or
inadvertent injury to the vocal cords (2). Patient factors causing
difficult exposure include a short neck, macroglossia, retrognathia,
obesity or extension limitation of the cervical spine.
Objectives: This technical note outlines how an intubating bougie can be
used as a guide for flexible biopsy forceps in these difficult cases, to
obtain biopsy samples. The Eschmann tracheal tube introducer (also known
as the gum elastic bougie) is a 60cm long, 15 French gauge flexible
plastic device with a central lumen and a J angle at the distal tip (see
figure 1) (3). It can be shaped as required.