Discussion
Although angled telescopes and curved instrumentation may help overcome challenges of difficult laryngeal access, we found that the flexible biopsy forceps loaded down the lumen of a bougie is a useful adjunct for more challenging cases. They are also readily available in most hospitals. When using the flexible biopsy forceps alone, it was found that there was not enough rigidity and guidance and the jaws often missed the lesion. The bougie technique offers the rigidity needed and as the plastic has memory, it will stay in the position required to access difficult areas to obtain adequate samples needed for histological diagnosis.