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Israel rake retractor modification to improve exposure during oropharyngeal surgery on patients with larger body habitus

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Elective oropharyngeal surgery including tonsillectomy and uvulopalatopharyngoplasty performed for obstructive sleep apnea is increasingly performed on patients of larger body habitus. The use of the Crowe-Davis retractor in such patients may be complicated by a large barrel-chest making it difficult to anchor the retractor to the Mayo stand for suspension limiting oropharyngeal exposure. Here, we present a simple modification using the Israel Retractor to facilitate suspension of the Crowe-Davis mouth gag.


Operational instructions were followed for Israel retractor modification in oropharyngeal surgery.


The Crowe-Davis retractor is able to anchor to the Israel retractor, whose prongs articulate on the Mayo Stand for suspension. This extension allows suspension of patients with larger body habitus in oropharyngeal surgery.


Use of the Israel retractor as an extension of the Crowe-Davis retractor handle provides an easy, quick, safe, and reliable method for placing patients of larger body habitus into suspension.

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  1. 1.

    Franklin KA, Lindberg E (2015) Obstructive sleep apnea is a common disorder in the population-a review on the epidemiology of sleep apnea. Journal of thoracic disease 7(8):1311–1322. https://doi.org/10.3978/j.issn.2072-1439.2015.06.11

  2. 2.

    Jordan AS, McSharry DG, Malhotra A (2014) Adult obstructive sleep apnoea. Lancet (London, England) 383(9918):736–747. https://doi.org/10.1016/s0140-6736(13)60734-5

  3. 3.

    Lee W, Nagubadi S, Kryger MH, Mokhlesi B (2008) Epidemiology of obstructive sleep apnea: a population-based perspective. Expert review of respiratory medicine 2(3):349–364. https://doi.org/10.1586/17476348.2.3.349

  4. 4.

    Toh ST, Han HJ, Tay HN, Kiong KL (2014) Transoral robotic surgery for obstructive sleep apnea in Asian patients: a Singapore sleep centre experience. JAMA otolaryngology-- head & neck surgery 140(7):624–629. https://doi.org/10.1001/jamaoto.2014.926

  5. 5.

    (NCD-RisC). NRFC (2016) Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19.2 million participants. Lancet (London, England) 387 (10026):1377–1396. doi:https://doi.org/10.1016/s0140-6736(16)30054-x

  6. 6.

    Ameer F, Singh A, Kumar S (2014) The story of mouth gags. Journal of Cleft Lip Palate and Craniofacial Anomalies 1(2):70–77. https://doi.org/10.4103/2348-2125.137893

  7. 7.

    Hoefert S (2013) The evolution of mouth gags. Presentation of a new modificated denhart mouth gag. Journal of maxillofacial and oral surgery 12(4):475–479. https://doi.org/10.1007/s12663-012-0417-z

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Author information

Correspondence to Andrew M. Vahabzadeh-Hagh.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

Additional information


This manuscript describes a technique for that is very simple and easy to incorporate to optimize visualization of the oropharynx with the Crowe-Davis retractor by incorporating the use of the Israel retractor which can be used to suspend on a Mayo Stand. This is an interesting and novel idea, and I am grateful to the authors for providing this interesting perspective. These insights may prove useful to many surgeons faced with the responsibility of operating on overweight and obese patients.

Soroush Zaghi


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Vahabzadeh-Hagh, A.M., Ramirez, E. Israel rake retractor modification to improve exposure during oropharyngeal surgery on patients with larger body habitus. Sleep Breath 21, 959–962 (2017). https://doi.org/10.1007/s11325-017-1569-3

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  • Obstructive sleep apnea
  • Oropharynx
  • Sleep apnea
  • Sleep surgery