title: Evaluation of modified Killian's method: a technique to expose the hypopharyngeal space.
abstract: OBJECTIVE
  The objective of this study was to evaluate the "Modified Killian's method," a recently proposed endoscopic technique to observe a wider area of the hypopharngeal space than is possible with the conventional method.
  
  
  METHODS
  Prospective case series.
  
  
  METHODS
  Fifty-seven patients underwent transnasal flexible endoscopy in a sequence of eight different procedures with or without head torsion, the Valsalva maneuver, and a position similar to bowing named "the modified Killian position." The visibility of subsites of the hypopharynx and esophageal inlet was evaluated based on a 5-point scale.
  
  
  RESULTS
  The Modified Killian's method, a combination of all three procedures of head torsion, the Valsalva maneuver, and the modified Killian position, demonstrated a highly significant score for hypopharyngeal visibility. Previous treatment with radiotherapy or chemoradiotherapy did not significantly affect the visibility of the hypopharynx.
  
  
  CONCLUSIONS
  The newly proposed Modified Killian's method provides an effective view of the entire circumference of the hypopharyngeal space even in patients receiving radiotherapy. This useful procedure can be performed easily and should be a part of flexible laryngoscopy for outpatients.
  
  
  METHODS
  4.
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Kanazawa University, Kanazawa, Japan.
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Murono
authors.forename: Akira
authors.initials: A
authors.lastname: Tsuji
authors.forename: Kazuhira
authors.initials: K
authors.lastname: Endo
authors.forename: Satoru
authors.initials: S
authors.lastname: Kondo
authors.forename: Naohiro
authors.initials: N
authors.lastname: Wakisaka
authors.forename: Tomokazu
authors.initials: T
authors.lastname: Yoshizaki
mesh_terms: D000704:Analysis of Variance; D059248:Chemoradiotherapy / Q000379:methods; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D007013:Hypopharynx / Q000528:radiation effects; D007828:Laryngoscopy / Q000379:methods*; D008297:Male; D056888:Patient Positioning / Q000379:methods*; D011446:Prospective Studies; D011882:Radiotherapy, High-Energy / Q000379:methods*; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014636:Valsalva Maneuver
keywords: Killian position; Valsalva maneuver; flexible laryngeal endoscopy; head torsion; hypopharyngeal space