Examples of pediatric laryngoscopes, including the Lindholm (left), Parsons (middle), and Philips (right)
Suspension Arms
Once the larynx is exposed, patient can be placed into suspension for further examination or operative intervention. The Parsons and Lindholm can be connected to a Lewy arm which is placed on a Mayo stand or Mustard stand for suspension.
Telescopes and Bronchoscopes
0-, 30-, and 70-degree telescopes should be available for close evaluation of the larynx. Examination can start with the 0-degree telescope to assess the supraglottis, superior glottis, subglottis, trachea, and proximal bronchi. The 30- and 70-degree telescopes can aid in close assessment of the anterior commissure, ventricles, and infraglottic surfaces of the true vocal folds. The telescope should be connected to a light cord for illumination and video camera for recording and projection of the image on a monitor.
Ventilating bronchoscope with attachments including telescope (a), light prism (b), ventilatory circuit attachment (c), and suction (d). A bridge (e) connects the telescope to the bronchoscope
Patient age with corresponding estimated diameter of the cricoid and trachea as well as the corresponding appropriate size bronchoscope to use
Age | <1 month | 1–6 months | 6–18 months | 18–36 months | 3–6 years | 6–9 years | 9–12 years | >12 years | |
|---|---|---|---|---|---|---|---|---|---|
Cricoid diameter | ID | 3.6–4.8 | 4.8–5.8 | 5.8–6.5 | 6.5–7.4 | 7.4–8.2 | 8.2–9.0 | 9.0–10.7 | 10.7+ |
Trachea diameter | ID | 5 | 5–6 | 6–7 | 7–8 | 8–9 | 9–10 | 10–13 | 13+ |
Bronchoscope | Size | 2.5 | 3.0 | 3.5 | 3.7–4.0 | 5.0 | 5.0–6.0 | 6.0 | 6.0 |
ID | 3.5 | 4.3 | 5.0 | 5.7–6.0 | 7.1 | 7.1–7.5 | 7.5 | 7.5+ | |
OD | 4.0 | 5.0 | 5.7 | 6.4–6.7 | 7.8 | 7.8–8.2 | 8.2 | 8.2+ |
Microlaryngeal Instruments
Microlaryngeal instruments which can be helpful during general assessment include the vocal cord retractor/posterior glottic spreader and the right-angle probe. The vocal cord retractor can be placed in an inverted fashion to lateralize the false vocal folds while still allowing the surgeon access to the posterior laryngeal structures and the interarytenoid area. The retractor is then suspended via rubber bands onto the suspension apparatus to provide hands-free exposure. Care must be taken during placement to avoid injury to the true vocal folds. The right-angle probe is helpful in multiple ways. First, it can be used to palpate the interarytenoid space to evaluate for a laryngeal cleft. Second, it can be used to palpate the true vocal folds in a systematic fashion to evaluate for scar, sulcus vocalis, or other glottic abnormality such as a submucosal cyst. During palpation, the probe is placed perpendicular to the vocal fold and passed over its surface in an inferior to superior fashion. This motion is performed over the length of the vocal fold and then repeated on the other side. In this way, subtle changes in vocal fold stiffness can be appreciated that might otherwise be missed on visualization alone. This is especially important when a submucosal cyst is suspected.
Instrument Table Setup
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