Primordial Laryngeal Inlet

2020 ◽  
Author(s):  
Keyword(s):  
Laryngeal Inlet

The Glottic Aperture Seal Airway 

1998 ◽  
Vol 88 (5) ◽  
pp. 1219-1226 ◽  
Author(s):  
Jonathan L. Benumof
Keyword(s):  
Laryngeal Mask Airway ◽  
Control Device ◽  
Laryngeal Mask ◽  
Posterior Surface ◽  
Balloon Inflation ◽  
Proximal Half ◽  
Laryngeal Inlet ◽  
Airway Devices ◽  
Ventilatory Device ◽  
Ventilation Hole

Background None of the presently used airway devices are ideal regarding ease of insertion, alignment with the laryngeal inlet, and provision of a high-pressure seal from the environment. The purpose of this study was to determine, in awake volunteers, the performance of a new ventilatory device, the glottic aperture seal airway, regarding ease of insertion, alignment with the laryngeal inlet, and forced exhalation seal pressure (PFES). Methods The glottic aperture seal airway consists of a curved tubular component that ends in the middle of an elliptical foam cushion glottic component. The posterior surface of the foam has a curved flexible plastic backing, which imparts a 60 degree angle between the proximal half and the distal half of the foam cushion. When the glottic aperture seal airway is properly in situ in a supine patient, the proximal half of the foam cushion is opposite the laryngeal inlet. The posterior surface of the plastic backing has a balloon attached to it. Inflation of the balloon presses the ventilation hole and foam cushion up against the laryngeal inlet, thereby creating a seal from the environment. Using the laryngeal mask airway as a control device, the glottic aperture seal airway was tested for time and ease of insertion, fiberoptic alignment with the laryngeal inlet, and PFES in 18 lightly sedated and locally anesthetized volunteers. Results The glottic aperture seal and laryngeal mask airways were inserted with equal ease and speed. The fiberoptic alignment with the larynx was excellent for both the glottic aperture seal and laryngeal mask airways. In all volunteers, the mean +/- SD PFES values at 0-, 10-, 20-, 30-, and 40-ml balloon inflation volumes of the glottic aperture seal airway were 23.4 +/- 11.8, 29.6 +/- 12.4, 42.7 +/- 12.5, 56.9 +/- 5.6, and 60 +/- 0 cm H2O, respectively; the PFES at > or = 20 ml balloon inflation volume of the glottic aperture seal airway was significantly greater than with the laryngeal mask airway (19.4 +/- 6.7 cm H2O, P < 0.01). A PFES of > or =60 cm H2O was achieved with the glottic aperture seal airway in all volunteers (n = 2 at 10 ml, n = 3 at 20 ml, n = 9 at 30 ml, and n = 4 at 40 ml). The glottic aperture seal airway did not cause any trauma. Conclusion In awake volunteers, the glottic aperture seal and laryngeal mask airways were equally easy to insert and position. The glottic aperture seal airway was capable of achieving a higher PFES than the laryngeal mask airway.

scholarly journals Direct laryngoscopy versus video laryngoscopy for expected difficult tracheal intubation a prospective observational study

2021 ◽  
Vol 8 (2) ◽  
pp. 277-282
Author(s):  
Venugopal Achuthan Nair ◽  
Brahmanandan Radhika Devi ◽  
Jagathnath Krishna Kumarapillai Mohanan Nair ◽  
Cherian Koshy Rachel ◽  
Munish Palliyalil Kakkolil
Keyword(s):  
Social Sciences ◽  
Tracheal Intubation ◽  
Prospective Observational Study ◽  
Elective Surgery ◽  
Difficult Tracheal Intubation ◽  
Intubation Time ◽  
Airway Assessment ◽  
Laryngeal Inlet ◽  
The Social ◽  
Spss Software

: Difficult tracheal intubation still contributes significantly to anaesthesia related morbidity and mortality. Poor visualisation of laryngeal structures and multiple attempts at intubation are the leading causes with the conventional laryngoscopes. Though the recently introduced video assisted devices have significantly improved the ease of intubation by their superior laryngeal visualisation, the duration of intubation may vary. Here we compared the ease of tracheal intubation using Macintosh conventional direct laryngoscope (DL) and C- MAC videolaryngoscope (VL) in patients with expected difficult tracheal intubation. A total of 140 patients undergoing elective surgery under general anaesthesia with Modified Mallampati Class 3 and 4 found during the preoperative airway assessment were equally recruited to either of the groups. We compared the duration of tracheal intubation, visualisation of the laryngeal inlet, additional optimising manoeuvres required, and number of attempts at intubation and incidence of oral trauma assessed at extubation between the two groups.: Analysis done using Statistical Packages for the Social Sciences (SPSS) software; Windows version 11.0 (SPSS Inc., Chicago, IL, USA). Intubation time was significantly longer in patients with VL than DL (P 0.0001) whereas visualisation of laryngeal inlet was significantly better with VL (P 0.001). Additional optimising manoeuvres (P 0.001) and incidence of oral trauma (P 0.012) were significantly less with VL whereas intubation attempts were found comparable (P 0.586).: Though VL provided significantly better laryngeal view with less need for optimising manoeuvres and less oral trauma compared to DL, the duration of intubation was significantly more with the former.

Impact of videolaryngoscopy introduction into prehospital emergency medicine practice: a quality improvement project

2021 ◽  
pp. emermed-2020-209944
Author(s):  
Alistair Steel ◽  
Charlotte Haldane ◽  
Dan Cody
Keyword(s):  
Emergency Medicine ◽  
Tracheal Intubation ◽  
Airway Management ◽  
First Line ◽  
Prehospital Emergency Medicine ◽  
Laryngeal Inlet ◽  
Advanced Airway ◽  
Intubation Success ◽  
First Pass ◽  
Prehospital Emergency

IntroductionAdvanced airway management is necessary in the prehospital environment and difficult airways occur more commonly in this setting. Failed intubation is closely associated with the most devastating complications of airway management. In an attempt to improve the safety and success of tracheal intubation, we implemented videolaryngoscopy (VL) as our first-line device for tracheal intubation within a UK prehospital emergency medicine (PHEM) setting.MethodsAn East of England physician–paramedic PHEM team adopted VL as first line for undertaking all prehospital advanced airway management. The study period was 2016–2020. Statistical process control charts were used to assess whether use of VL altered first-pass intubation success, frequency of intubation-related hypoxia and laryngeal inlet views. A survey was used to collect the team’s views of VL introduction.Results919 patients underwent advanced airway management during the study period. The introduction of VL did not improve first-pass intubation success, view of laryngeal inlet or intubation-associated hypoxia. VL improved situational awareness and opportunities for training but performed poorly in some environments.ConclusionDespite the lack of objective improvement in care, subjective improvements meant that overall PHEM clinicians wanted to retain VL within their practice.

scholarly journals Linear Growth Study of the Pharyngeal Cavity

1973 ◽  
Vol 52 (6) ◽  
pp. 1245-1248 ◽  
Author(s):  
Walter A. Castelli ◽  
Perla C. Ramirez ◽  
Carlos E. Nasjleti
Keyword(s):  
Linear Growth ◽  
Growth Study ◽  
Pharyngeal Cavity ◽  
Rate Of Growth ◽  
Linear Dimensions ◽  
Laryngeal Inlet ◽  
Oral Opening ◽  
Cephalometric Study

A cephalometric study was made to determine average linear dimensions and growth differentials of the pharyngeal cavity in boys and girls 6 to 15 years of age. The length of the cavity and its nasal openings had a faster rate of growth in boys than in girls, especially during puberty. Oral opening and laryngeal inlet did not vary between sexes.

State-Dependent Laryngomalacia

1997 ◽  
Vol 106 (11) ◽  
pp. 887-890 ◽  
Author(s):  
Milan R. Amin ◽  
Glenn Isaacson
Keyword(s):  
Soft Tissue ◽  
Inspiratory Stridor ◽  
Awake State ◽  
Flexible Laryngoscopy ◽  
Normal Breathing ◽  
Laryngeal Inlet ◽  
State Dependent ◽  
Level Of Consciousness ◽  
Condition State

We have observed 5 infants who demonstrate normal breathing when awake, but develop stridor while asleep. Flexible laryngoscopy in the awake state reveals either a normal larynx or redundancy of the aryepiglottic folds or arytenoid soft tissue without prolapse into the laryngeal inlet. When these children are sedated, however, the classic signs of laryngomalacia appear. Wet inspiratory stridor with concomitant supraglottic prolapse can be demonstrated by flexible videolaryngoscopy in this state. As these findings vary with level of consciousness, we have dubbed this condition “state-dependent” laryngomalacia. We believe the appearance and disappearance of classic laryngomalacia with changes in level of consciousness adds credence to the neurogenic theory of laryngomalacia.

Function of upper esophageal sphincter during swallowing: the grabbing effect

1997 ◽  
Vol 272 (5) ◽  
pp. G1057-G1063
Author(s):  
P. Pouderoux ◽  
P. J. Kahrilas
Keyword(s):  
Healthy Volunteers ◽  
Axial Force ◽  
Traction Force ◽  
Force Transducer ◽  
Upper Esophageal Sphincter ◽  
Cervical Esophagus ◽  
Sphere Diameter ◽  
Laryngeal Inlet ◽  
Pharyngeal Swallow ◽  
Esophageal Sphincter

This study investigated deglutitive axial force developed within the pharynx, upper esophageal sphincter (UES), and cervical esophagus. Position and deglutitive excursion of the UES were determined using combined manometry and videofluoroscopy in eight healthy volunteers. Deglutitive clearing force was quantified with a force transducer to which nylon balls of 6- or 8-mm diameter were tethered and positioned within the oropharynx, hypopharynx, UES, and cervical esophagus. Axial force recordings were synchronized with videofluoroscopic imaging. Clearing force was dependent on both sphere diameter (P < 0.05) and location, with greater force exhibited in the hypopharynx and UES compared with the oropharynx and esophagus (P < 0.05). Within the UES, the onset of traction force coincided with passage of the pharyngeal clearing wave but persisted well beyond this. On videofluoroscopy, the persistent force was associated with the aboral motion of the ball caught within the UES. Force abated with gradual slippage of the UES around the ball. The force attributable to the combination of UES contraction and laryngeal descent was named the grabbing effect. The grabbing effect functions to transfer luminal contents distal to the laryngeal inlet at the end of the pharyngeal swallow, presumably acting to prevent regurgitation and/or aspiration of swallowed material.

Factors in Successful Deglutition following Supraglottic Laryngeal Surgery

1982 ◽  
Vol 91 (6) ◽  
pp. 579-583 ◽  
Author(s):  
Toribio C. Flores ◽  
Benjamin G. Wood ◽  
Lawrence Koegel ◽  
Howard L. Levine ◽  
Harvey M. Tucker
Keyword(s):  
Cricopharyngeal Myotomy ◽  
Swallowing Function ◽  
Cricopharyngeal Muscle ◽  
Base Of Tongue ◽  
Laryngeal Surgery ◽  
Laryngeal Inlet ◽  
Base Of The Tongue

Aspiration is the major problem in deglutition associated with conservation laryngeal surgery. Closure of the glottic sphincter, depression of the epiglottis over the laryngeal inlet, elevation of the thyrohyoid complex under cover of the base of the tongue and appropriate relaxation of the cricopharyngeal muscle to permit unobstructed passage of food into the esophagus are important mechanisms that prevent food from entering the trachea. Partial laryngeal surgery can interfere with one or a combination of these mechanisms. Analysis of the records of all evaluable patients who underwent horizontal supraglottic resections from January 1976 to June 1981 was undertaken. The incidence of deglutition problems is reported. In addition, the effects of resection or preservation of the hyoid, arytenoid, base of tongue and branches of the vagus and the effect of cricopharyngeal myotomy upon ultimate swallowing function are analyzed.

Neonatal and paediatric fibre-optic laryngoscopy and bronchoscopy using the laryngeal mask airway

1997 ◽  
Vol 111 (4) ◽  
pp. 349-353 ◽  
Author(s):  
A. E. Hinton ◽  
J. M. O'Connell ◽  
J. P. Van Besouw ◽  
M. E. Wyatt
Keyword(s):  
Laryngeal Mask Airway ◽  
Vascular Ring ◽  
Ease Of Use ◽  
Laryngeal Mask ◽  
Fibre Optic ◽  
Upper Airways ◽  
Vocal Fold Paresis ◽  
Endoscopic View ◽  
Laryngeal Inlet ◽  
Neonates And Infants

AbstractEndoscopy of the upper airways in neonates and infants has traditionally been accomplished using rigid laryngoscopes and bronchoscopes. The laryngeal mask may be used both to control the airway for anaesthetic ventilation and to guide a fibre-optic endoscope to the laryngeal inlet and beyond.We report our experience with five neonatal and paediatric cases where fibre-optic laryngoscopy and bronchoscopy were performed through the laryngeal mask airway. All were cases in which standard rigid endoscopy had proved difficult with only a poor and restricted view of the laryngeal inlet being obtained due to the age of the infants, or abnormal anatomy of the upper airways.No problems have been encountered with maintenance of the airway or with the endoscopic view obtained. In fact in neonatal patients, this technique has been found to be preferable with regard to safety and ease of use when compared to the ventilating bronchoscope. With the size 1 laryngeal mask airway it is not possible to simultaneously ventilate and endoscope the patient. Cases included, a vascular ring, Goldenhar's syndrome, laryngomalacia, supraglottis and vocal fold paresis.This technique provides a secure method of maintaining anaesthetic ventilation during airway endoscopy, and also a means of easily locating the glottis.

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