Pediatric Laryngoscopes

Introduction:
     This article is relevant in the present day scenario as more and more children under go endolaryngeal surgeries.  With efficient neonatal intensive care units, large number of premature / low birth weight babies thrive these days.  As the old adage goes "A child is not a miniature adult" it is imperative that equipment design should keep pace with the advancing science.  Pediatric larynx is unique in many ways.  It is placed high up in the neck, the overhanging omega shaped epiglottis makes visualization of larynx nearly impossible.  It is important to design laryngoscopes that could overcome these anatomical variations.  This article discusses the various laryngoscopes available for use in pediatric age group of patients.

Pediatric laryngoscopes can be classified into:


1. General purpose laryngoscopes

2. Laryngoscopes designed for special purposes



General purpose laryngoscopes:

These are designed with the intention of providing a good view of

oropharynx, laryngeal inlet and laryngopharynx of an infant.There are two

varieties of general purpose laryngoscopes:

Karl storz

Parson's.



Karl storz - The general purpose laryngoscope designed by karl storz can be used

for both diagnostic and intubation purposes.These are available in 4 sizes:

1. 8 cms for premature and newborns

2. 9.5 cms for infants

3. 11 cms for children

4. 13.5 cms for adolescents



These differing sizes will enable proper placement of the beak of laryngoscope

either in vallecula or behind the epiglottis. Proper placement of the beak of

laryngoscope will ensure better field of vision of oropharynx and laryngopharynx.

Illumination is provided by proximal prismatic deflector. Light is transmitted to the

prismatic deflector via a thin fibre optic cable which passes via the handle of the

laryngoscope.

Parsons laryngoscopes are a variety of paediatric laryngoscopes.


It is usually available in three sizes.



1. 8 cms for premature babies / new borns



1. 9.5 cms for infants



2. 11 cms for toddlers and older children



on being positioned over the posterior 1/3 of tongue a wide view of

laryngopharynx can be seen. It can be connected to suspension apparatus

helping the surgeon in laryngeal examination and surgeries leaving both

hands free. Another important advantage is the presence of a side port

on the left side through which a cannula can be introduced to pass anesthetic

gases. It has another port on the right side though which fibre optic

attachement can be passed for illumination purposes.



It is very useful in laser endolaryngeal surgeries.



Telescopes can also be passed through the left port for complete

examination of larynx and laryngopharynx.



Special purpose laryngoscopes: These are usually operating laryngoscopes used during surgical procedures

involving larynx. These include:



1.Benjamin Lindholm laryngoscope

2.Holinger Benjamin laryngoscope

3.Benjamin operating laryngoscope



Benjamin Lindholm laryngoscope: is available in two sizes.

9.5cms for premature babies and 11 cms for children from 18 months - 8 years of age

When the beak is placed a wide view of laryngopharnx is available. Since it is provided

with suspension system both arms are free for manipulation. It has a special cannula which

is fixed to the left side of the laryngoscope. Through this cannula anesthetic gases can

be insufflated. The laryngoscope provides a wide exposure for microlaryngeal and laser

surgeries.



Holinger Benjamin laryngoscopes:is manufactured in three sizes:



1. 9.5 cms with a very narrow distal end for very low birth weight new born babies

2. 9.5 cms with a larger distal end for new born babies

3. 11 cms for older children



By virtue of their design these laryngoscopes help in full visualization of anterior commissure,

posterior glottic space and subglottic area. This laryngoscope can be used for difficult intubation

scenarios. Since the blade of these laryngoscopes are slim and slightly upturned, it is helpful in

intubating patients with difficult mouth opening like Pierre Robin syndrome. This scope is very

useful in diagnosing congenital webs involving larynx.



Benjamin operating laryngoscopes:

These are available in two sizes. These scopes allow binocular vision during microlaryngeal / laser

surgeries. These scopes are provided with portal for anesthetic gas insufflation.
 
 
 

This image shows a Parson's laryngoscope

Lindholm's laryngoscope