Micro-Direct Laryngoscopy (MDL) - basic

Considerations

• For Dr. Jiang and Dr. Durr, see the book Operative Techniques in Laryngology (2008) by Rosen and Simpson.

Preparation

• • ETT: Smallest armored tube

    • Tape to left lower lip

• Eyes: Paper tape over lids

  • Wet "eye pads" over tape

  • Another long strip of paper tape over both eye pads

• Head: Wrap with 2 blue towels

  • Avoid towel clamp 

• Split drape 

  • Do not remove sticky cover 

• Tooth guard 

• Check all equipment including light cables and light sources 

Procedure

• • Basic DL with either/or 

    • Hollinger (anterior commissure) laryngoscope 

    • Dedo laryngoscope 

• Place the operative larygoscope in suspension

  • Bouchayer laryngoscope 

  • Zeitels laryngoscope

• Adjust the head and neck positioning as needed

  • Sniffing position (neck flexion with head extension)

  • Anterior tracheal pressure with tape 

• Photograph using both 0 and 30 degree Hopkins rod endoscope 

• Bring in the operative microscope 

• Perform the planned surgery

  • If performing steroid injection, may use 1 ml Dexamethasone (4 mg/ml) on luer lock 1 ml syringe 

• Obtain hemostasis with small pledget soaked with topical 1:1000 Epinephrine 

• Photograph using both 0 and 30 degree Hopkins rod endoscope 

  • Spray the glottis with 3 ml topical 4% Lidocaine

  • Remove the laryngoscope and tooth guard

  • Examine the airway for any unintentional injury 

Post-op

• • For Dr. Durr, use the the University of Texas Voice Rest protocol here

    • See the smartphrase by J Gilde: JEGPIVOICERESTPO

High-Yield

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