Modern surgery, general and operative . the right side of the patients tongue (Fig. 566)and the pyriform sinus sought immediately to the right of the right arytenoid. Chevalier Jacksons Tracheobronchoscopy 889 Once the tube mouth is in the sinus, very gentle pressure is used, and thelumen of the mouth of the esophagus is watched for and followed at the momentof inspiration. Absolutely no force should be used, and no attempt to advancethe tube should be made except at the moments when the patient takes adeep breath, which he must be encouraged to do. It is the spasm of theinferior constrictor a
Modern surgery, general and operative . the right side of the patients tongue (Fig. 566)and the pyriform sinus sought immediately to the right of the right arytenoid. Chevalier Jacksons Tracheobronchoscopy 889 Once the tube mouth is in the sinus, very gentle pressure is used, and thelumen of the mouth of the esophagus is watched for and followed at the momentof inspiration. Absolutely no force should be used, and no attempt to advancethe tube should be made except at the moments when the patient takes adeep breath, which he must be encouraged to do. It is the spasm of theinferior constrictor at the cricoid level that gives the trouble. Once this ispassed, the lumen of the cervical esophagus is easily explored, and the thoracicesophagus opens widely at each recurrence of the inspiratory negative intra-thoracic pressure. Passing the hiatus esophageus requires a moment for therelaxation of spasm and the tube must be directed slightly upward (recumbentpatient) to the left. Esophagoscopy is useful for the detection of acute and. Fig. 566.—^Introduction of the esophagoscope under guidance of the eye. The tube-mouth is justentering the pyriform sinus. The assistant is holding the head in extreme extension and nurse at the left is manipulating the aspirator for the removal of secretions without interruptionof the operators work (ChevaHer Jackson). chronic esophagitis, ulceration, diverticulum, dilatation, paralysis, and variousstenotic diseases, such as cicatricial stenosis following the ulceration of s>T)hilis,typhoid fever, corrosive poisoning by bichlorid of mercury, caustic alkalis,acids, etc. Cicatricial stenoses are dilated under guidance of the eye witholives, divulsers, and silkworm bougies left in situ for a few hours. Obstinatecases may require endoscopic esophagotomy. Stenosis may be due to neoplas-tic involvement of the esophageal wall when the growth will be visible endo-scopically, or the stenosis may be compressive, when the esophageal walls
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Keywords: ., bookcentury1900, bookdecade1910, bookpublishe, booksubjectsurgery
