title: A new technique to expose the hypopharyngeal space: The modified Killian's method.
abstract: OBJECTIVE
  Recent remarkable progress in endoscopic technology has enabled the detection of superficial cancers that were undetectable in the past. However, even though advanced endoscopic technology can detect early lesions, it is useless unless it can provide wide exposure of an area. By modifying the Killian position, it is possible to observe a wider range of the hypopharyngeal space than is possible with conventional head positions. We report a revolutionary method that uses a new head position to widely open the hypopharynx. The technique is named "the Modified Killian's method."
  
  
  METHODS
  The patient is initially placed in the Killian position and then bent further forward from the original position (i.e., the modified Killian position). While in this position, the patient's head is turned and the Valsalva maneuver is applied. These additional maneuvers constitute the Modified Killian's method and widely expands the hypopharyngeal space.
  
  
  RESULTS
  The conventional head position cannot open the hypopharyngeal space sufficiently; however, the Modified Killian's method opens the hypopharyngeal space very widely.
  
  
  CONCLUSIONS
  The Modified Killian's method enables observation of the entire circumference of the hypopharyngeal space and the cervical esophageal entry. The Modified Killian's method may become an indispensable technique for observing the hypopharynx and detecting hypopharyngeal cancers.
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Tokai University, School of Medicine, Isehara, Japan. Electronic address: asakai-ygc@umin.ac.jp.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Sakai
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Tokai University, School of Medicine, Isehara, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Okami
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Tokai University, School of Medicine, Isehara, Japan.
authors.forename: Ryousuke
authors.initials: R
authors.lastname: Sugimoto
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Tokai University, School of Medicine, Isehara, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Ebisumoto
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Tokai University, School of Medicine, Isehara, Japan.
authors.forename: Hikaru
authors.initials: H
authors.lastname: Yamamoto
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Tokai University, School of Medicine, Isehara, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Maki
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Tokai University, School of Medicine, Isehara, Japan.
authors.forename: Kosuke
authors.initials: K
authors.lastname: Saito
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Tokai University, School of Medicine, Isehara, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Iida
mesh_terms: D004724:Endoscopy / Q000379:methods*; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000601:surgery*; D007013:Hypopharynx / Q000601:surgery*; D056888:Patient Positioning / Q000379:methods*; D012399:Rotation; D014636:Valsalva Maneuver
keywords: Hypopharyngeal space; Killian position; NBI endoscope; Valsalva maneuver