European Archives of Oto-Rhino-Laryngology

, Volume 270, Issue 1, pp 243–247

Study of the head and neck position in microlaryngoscopy using magnetic resonance imaging

Laryngology

Abstract

Several studies have critically analyzed the ideal position for laryngeal exposure during microlaryngoscopy; however, these studies have lacked the ability to evaluate the head and neck position while maintaining a direct view into the airway. Therefore, a newly established two-curve methodology was used to investigate the influence of head and neck position during microlaryngoscopy in MRI images. Fourteen normal adult volunteers were used in this magnetic resonance imaging study. The airway was divided into two curves in the sagittal plane at the center of the airway in three head and neck positions: extension–extension, neutral and flexion–extension position. The airway passage curves, point of inflection and its tangent, the line of laryngoscope, line of hyoid bone and mandible were plotted on each scan. Angles and area formed by these lines were calculated to evaluate the airway morphology changes. The flexion–extension position caused a reduction in the area between the line of laryngoscope and curves, but there was no significant difference between the three positions (p = 0.664). The flexion–extension position also resulted in the lowest angle values for α (angle between the tangent and horizon, p = 0.000), β (between the line of hyoid and horizon, p = 0.002) and δ (between the line of mandible and horizon, p = 0.004). Our study provides a better understanding of the changes in normal airway morphology during microlaryngoscopy in different positions, reinforcing the concept that flexion–extension position is the optimal position for microlaryngoscopy.

Keywords

Microlaryngoscopy Airway Head and neck Posture Magnetic resonance imaging 

References

  1. 1.
    Gugatschka M, Gerstenberger C, Friedrich G (2008) Analysis of forces applied during microlaryngoscopy: a descriptive study. Eur Arch Otorhinolaryngol 265(9):1083–1087PubMedCrossRefGoogle Scholar
  2. 2.
    Fang R, Chen H, Sun J (2012) Analysis of pressure applied during microlaryngoscopy. Eur Arch Otorhinolaryngol 269(5):1471–1476PubMedCrossRefGoogle Scholar
  3. 3.
    Hochman I, Zeitels SM, Heaton JT (1999) Analysis of the forces and position required for direct laryngoscopic exposure of the anterior vocal folds. Ann Otol Rhinol Laryngol 108(8):715–724PubMedGoogle Scholar
  4. 4.
    Vaughan CW (1993) Vocal fold exposure in phonosurgery. J Voice 7(2):189–194PubMedCrossRefGoogle Scholar
  5. 5.
    Zeitels SM, Vaughan CW (1994) External counterpressure and internal distension for optimal laryngoscopic exposure of the anterior glottal commissure. Ann Otol Rhinol Laryngol 103(9):669–675PubMedGoogle Scholar
  6. 6.
    Friedrich G, Gugatschka M (2009) Influence of head positioning on the forces occurring during microlaryngoscopy. Eur Arch Otorhinolaryngol 266(7):999–1003PubMedCrossRefGoogle Scholar
  7. 7.
    Adnet F, Borron SW, Lapostolle F, Lapandry C (1999) The three axis alignment theory and the ‘sniffing position’: perpetuation of an anatomic myth? Anesthesiology 91:1964–1965PubMedCrossRefGoogle Scholar
  8. 8.
    Adnet F, Borron SW, Dumas JL et al (2001) Study of the ‘sniffing position’ by magnetic resonance imaging. Anesthesiology 94:83–86PubMedCrossRefGoogle Scholar
  9. 9.
    Lee L, Weightman WM (2008) Laryngoscopy force in the sniffing position compared to the extension–extension position. Anaesthesia 63(4):375–378PubMedCrossRefGoogle Scholar
  10. 10.
    Greenland KB, Edwards MJ, Hutton NJ, Challis VJ, Irwin MG, Sleigh JW (2010) Changes in airway configuration with different head and neck positions using magnetic resonance imaging of normal airways: a new concept with possible clinical applications. Br J Anaesth 105(5):683–690PubMedCrossRefGoogle Scholar
  11. 11.
    Roh JL, Lee YW (2005) Prediction of difficult laryngeal exposure in patients undergoing microlaryngosurgery. Ann Otol Rhinol Laryngol 114:614–620PubMedGoogle Scholar
  12. 12.
    Hsiung MW, Pai L, Kang BH et al (2004) Clinical predictors of difficult laryngeal exposure. Laryngoscope 114:358–363PubMedCrossRefGoogle Scholar
  13. 13.
    Pinar E, Calli C, Oncel S, Selek B, Tatar B (2009) Preoperative clinical prediction of difficult laryngeal exposure in suspension laryngoscopy. Eur Arch Otorhinolaryngol 266(5):699–703PubMedCrossRefGoogle Scholar
  14. 14.
    Ohno S, Hirano S, Tateya I, Kojima T, Ito J (2011) Management of vocal fold lesions in difficult laryngeal exposure patients in phonomicrosurgery. Auris Nasus Larynx 38(3):373–380PubMedCrossRefGoogle Scholar
  15. 15.
    Jackson C (1915) Position of the patient for peroral endoscopy. In: Jackson C (ed) Peroral Endoscopy and Laryngeal Surgery. Laryngoscope Co., St. Louis, pp 77–88Google Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  1. 1.Department of Otorhinolaryngology, Head and Neck SurgeryEENT Hospital of Fudan UniversityShanghaiChina
  2. 2.Department of Otorhinolaryngology, Head and Neck SurgeryAnhui Provincial HospitalHefeiChina
  3. 3.The First Affiliated Hospital of Anhui Medical UniversityHefeiChina
  4. 4.Division of Otolaryngology, Head and Neck Surgery, Department of SurgeryUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA

Personalised recommendations