Exposure and visualization of the glottis for phonomicrosurgery

Adequate exposure of the vocal folds is a prerequisite for successful phonomicrosurgery. Paramount to this success is a glottiscope that can be inserted easily while providing stereoscopic exposure at all magnifications, and is conformed distally to the triangular shape of the glottis. The position of the glottiscope is optimally maintained in elevated vector suspension by a gallows rather than a fulcrum torsion laryngoscope-holder. In most circumstances, external counter-pressure further enhances microlaryngoscopic exposure of the vocal folds. A recent investigation suggests that flexion-flexion of the head an neck is the ideal position for the difficult intubation rather than the extension-flexion [sniffing/Boyce-Jackson position], which is classically taught. However, Boyce-Jackson position remains as the optimal position for phonomicrosurgery.