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.

A new technique to expose the hypopharyngeal space: The modified Killian's method.

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. CONCLUSION: 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.

Evaluation of modified Killian's method: a technique to expose the hypopharyngeal space.

OBJECTIVES/HYPOTHESIS: 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. STUDY DESIGN: 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. CONCLUSION: 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. LEVEL OF EVIDENCE: 4.