Improving the endoscopic view of the hypopharynx with anterior neck traction during the trumpet manoeuvre

Abstract

The postcricoid subsite is difficult to visualize on flexible laryngopharyngoscopy. The view can be improved with either auto-insufflation manoeuvres or anterior neck skin traction. In this study, the view of the hypopharynx was graded whilst anterior neck skin traction was applied during the trumpet manoeuvre; the latter involves the patient blowing on his finger as if blowing up a balloon. On auto-insufflation alone, the postcricoid site was demonstrated in 22/25 (88 per cent) of cases and the upper oesophageal sphincter (UOS) in two out of 25 (eight per cent). Of the 22 cases in whom only the postcricoid site was demonstrated, subsequent neck skin traction revealed the UOS in eight. Overall, the use of auto-insufflation solely or in combination with traction resulted in UOS visualization in 40 per cent (10/25) of cases. The application of skin traction during trumpeting is easy to perform and should be used routinely.

Enhancing Visibility of the Hypopharyngeal-Esophageal Region by Introduction of a Physiological Eructation Maneuver

“…Both methods do not differ significantly in terms of their effectiveness. By using the trumpet maneuver in combination with anterior neck skin traction, the proportion of patients with visible UES can be increased to 40% [5]. …”

“…In particular, special positioning maneuvers such as head torsion [4], anterior neck skin traction [5], or the Killian position and its modified variants [6] have been described. Other procedures, some of which are also used in combination with the aforementioned maneuvers, attempt to dilate the anatomical structures of the hypopharynx with gas.…”

How to improve the endoscopic view of the hypopharynx: Validation of our novel modified Killian's Method to expose the hypopharynx in 20 subjects

“…Although several methods to expose the hypopharynx are tried, we found it impossible to use them to obtain a satisfactory visual field. To address this problem, we devised a novel method by modifying the Killian position which we designated the Modified Killian's (MK) method .…”

Office‐based laryngology: Technical and visual optimization by patient‐positioning maneuvers

“…For improved computed tomography visualization of the piriform sinus and retrocricoid area, Hillel and Schwartz described the trumpet maneuver designed to insufflate the pharynx . For laryngoscopy, multiple manipulations have been described for improved laryngopharyngeal exposure . Tsunoda et al described a head torsion method to visualize the laryngeal ventricle and inferior surface of the vocal fold .…”

“…In patients with an oblique larynx, this maneuver was also found to improve insertion of the endoscope without obstruction of the epiglottis. Additionally, combinations of anterior traction, head torsion, insufflation, Valsalva, and chin‐to‐chest positioning have all been utilized to optimize laryngopharyngeal visualization during flexible laryngoscopy …”