_Mouth-gag_.--Wide gagging prevents proper exposure of the larynx by
forcing the mandible down on the hyoid bone. The mouth should be
gently opened and a bite block (Fig. 16) inserted between the teeth on
the left side of the patient's mouth, to prevent closing of the jaws
on the delicate bronchoscope or esophagoscope.
[FIG. 16.--Bite block to be inserted between the teeth to prevent
closure of the jaws on the endoscopic tube. This is the
McKee-McCready modification of the Boyce thimble with the omission of
the etherizing tube, which is no longer needed. The block has been
improved by Dr. W. F. Moore of the Bronchoscopic Clinic.]
_Forceps_.--Delicacy of touch and manipulation are an absolute
necessity if the endoscopist is to avoid mortality; therefore, heavily
built and spring-opposed forceps are dangerous as well as useless. For
foreign-body work in the larynx, and for the removal of benign
laryngeal growths, the alligator forceps with roughened jaws shown in
Fig. 17 serve every purpose.
[FIG. 17.--Laryngeal grasping forceps designed by Mosher. For my own
use I have taken off the ratchet-locking device for all general work,
to be reapplied on the rare occasions when it is required.]
_Bronchoscopic and esophagoscopic grasping forceps_ are of the tubular
type, that is, a stylet carrying the jaws works in a slender tube so
that traction on the stylet draws the V of the open jaws into the
lumen of the tube, thus causing the blades to approximate. They are
very delicate and light, yet have great grasping power and will
sustain any degree of traction that it is safe to exert. They permit
of the delicacy of touch of a violin bow. The two types of jaws most
frequently used, are those with the forward-grasping blades shown in
Fig. 18, and those having side-grasping blades shown in Fig. 19. The
side-curved forceps are perhaps the most generally useful of all the
endoscopic forceps; the side projection of the jaws makes them readily
visible during their closure on an object; their broader grasp is also
an advantage., The projection of the blades in the side-curved
grasping forceps should always be directed toward the left. If it is
desired that they open in another direction this should be
accomplished by turning the handle and not by adjusting the blade
itself. If this rule be followed it will always be possible to tell by
the position of the handle exactly where the blades are situated;
whereas, if the jaws themselves are turned, confusion is sure to
result. The forward-grasping forceps are always so adjusted that the
jaws open in an up-and-down direction. On rare occasions it may be
deemed desirable to turn the stylet of either forceps in some other
direction relative to the handle.
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