title: Improved airway visualization during direct laryngoscopy using self-retaining laryngeal retractors: a quantitative study.
abstract: OBJECTIVE
  To measure the degree to which the Lindholm laryngeal distending forceps improve visualization during direct laryngoscopy in selected pediatric patients.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  Pediatric hospital.
  
  
  METHODS
  Subjects included children undergoing direct laryngoscopy using the Lindholm laryngeal distending forceps. Intraoperative endoscopic photos with and without false cord retraction via the Lindholm laryngeal distending forceps were obtained from the Seattle Children's Hospital airway endoscopy photo library. Analysis was performed using imaging software. Comparisons of visible vocal cord and glottic opening areas as well as anterior commissure angles with and without the Lindholm laryngeal distending forceps were performed with a paired and unpaired Student t test.
  
  
  RESULTS
  The use of the Lindholm laryngeal distending forceps increased the glottic opening by a mean of 359% (95% confidence interval [CI], 255%-463%) and increased visualized true vocal cord area by 337% (197%-477%). Angle at the anterior commissure increased from a mean of 24.9° to a mean of 71.5°, resulting in a net mean angle increase of 46.6° (95% CI, 40.2°-52.9°). All measured changes were statistically significant with P values <.01.
  
  
  CONCLUSIONS
  When placed at the level of the false vocal folds, Lindholm laryngeal distending forceps will, at least in certain cases, greatly increase the visible area of the superior surface of the vocal folds, the anterior commissure, and, by increasing the glottic opening, the subglottic region. This improved visualization may enhance the surgeon's ability to diagnose and treat pathologies in these anatomic regions during direct laryngoscopy.
authors.affiliation: University of Washington School of Medicine, Seattle, Washington, USA.
authors.forename: Beck
authors.initials: B
authors.lastname: Longstreet
authors.forename: Prabhat K
authors.initials: PK
authors.lastname: Bhama
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Inglis
authors.forename: Babette
authors.initials: B
authors.lastname: Saltzman
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Perkins
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004867:Equipment Design; D005260:Female; D006801:Humans; D007223:Infant; D007818:Laryngeal Diseases / Q000175:diagnosis*; D020704:Laryngoscopes; D007828:Laryngoscopy / Q000379:methods*; D007830:Larynx / Q000473:pathology*; D008297:Male; D015203:Reproducibility of Results; D012189:Retrospective Studies; D055815:Young Adult