Manoeuvres to Improve Endoscopic Visualization of Hypopharynx

The more progress achieved in endoscopy, the more superficial cancers in head and neck region have been diagnosed. There are, however, some areas difficult to observe, particularly the hypopharynx, due to closure of this space. Examination of hypopharynx form an essential part of head and neck examination especially in the suspected malignancies as well as in the cases with unknown primary. As the flexible fiber-optic nasopharyngolaryngoscopy forms an essential part of examination of hypopharynx, the present study aims to evaluate the effectiveness of various manoeuvres devised to aid in better visualization of the hypopharynx. The present prospective study is an observation carried out on 30 patients, which had been followed up for hypopharyngeal or laryngeal disease, in the OPD of the department of Otorhinolaryngology and head and neck surgery in Gandhi Medical College and associated hospital, Bhopal, M.P. In the present study, authors compared the visibility of subsites of hypopharynx in 30 patients undergoing trans nasal flexible fibre optic endoscopy in normal seated position and with head torsion, valsalva manoeuvre and the Killian position. The authors concluded that the above mentioned manoeuvres facilitated the visualization of the entire circumference of the hypopharynx during endoscopic examination, are non invasive and easy to perform and so should be included as a part of routine examination while performing flexible fibre optic endoscopy.