{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T18:42:12Z","timestamp":1760985732315},"reference-count":14,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2018,10,16]],"date-time":"2018-10-16T00:00:00Z","timestamp":1539648000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["T35\u2010DK007386"],"award-info":[{"award-number":["T35\u2010DK007386"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2019,2]]},"abstract":"<jats:sec><jats:title>Objective\/Hypothesis<\/jats:title><jats:p>To qualitatively and quantitatively assess the effect of discrete head postures\/maneuvers during flexible laryngoscopy on visualization of specific anatomical structures within the laryngopharynx.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Prospective, observational study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Flexible laryngoscopy was performed on 18 sequential patients. Videos of the laryngopharynx were captured during the neutral head position and five discrete maneuvers: maximal sniffing, head extension, right turn, left turn, and chin down. Images were analyzed using ImageJ, and differences in the (normalized) anatomical areas of interest were examined with each maneuver (paired <jats:italic>t<\/jats:italic> test]. Covariates for surgeon, nostril, and gender were evaluated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There was a significantly increased (<jats:italic>P<\/jats:italic> = 0.009) area of view of the anterior space (petiole of epiglottis\/anterior laryngeal vestibule) with head extension. Right head turn led to a significantly increased view of the left pyriform sinus (<jats:italic>P<\/jats:italic> = 0.00001), whereas left head turn yielded an increased view of the right pyriform sinus (<jats:italic>P<\/jats:italic> = 0.0001). The right and left vocal fold\/ventricle were better visualized during right head turn (with the scope traversing the right nostril) and left head turn (with the scope traversing the left nostril), respectively. Chin\u2010down posture achieved a more distal view of the airway more frequently than the other maneuvers.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The anterior space (supraglottic larynx) may be best visualized and accessed with head extension. Right and left head turn improve visualization of the contralateral piriform sinus. Chin down provides improved airway visualization in a plurality of patients. Future studies examining maneuvers are warranted to create a catalog of validated techniques to optimize the efficacy of the office\u2010based proceduralist.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>2 <jats:italic>Laryngoscope<\/jats:italic>, 129:330\u2013334, 2019<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.27506","type":"journal-article","created":{"date-parts":[[2018,10,16]],"date-time":"2018-10-16T13:05:22Z","timestamp":1539695122000},"page":"330-334","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Office\u2010based laryngology: Technical and visual optimization by patient\u2010positioning maneuvers"],"prefix":"10.1002","volume":"129","author":[{"given":"Ameer","family":"Ghodke","sequence":"first","affiliation":[{"name":"University of North Carolina School of Medicine  Chapel Hill North Carolina U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Douglas R.","family":"Farquhar","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery the University of North Carolina School of Medicine  Chapel Hill North Carolina U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert A.","family":"Buckmire","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery the University of North Carolina School of Medicine  Chapel Hill North Carolina U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rupali N.","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery the University of North Carolina School of Medicine  Chapel Hill North Carolina U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,10,16]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.23630"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvoice.2018.01.011"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvoice.2017.07.018"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.25007"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otohns.2006.01.019"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1288\/00005537-190706000-00001"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.2880110307"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.2880170505"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1258\/0022215001905562"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.anl.2013.10.012"},{"key":"e_1_2_6_12_1","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1017\/S0022215106005251","article-title":"Head torsion technique for detailed observation of larynx and hypopharynx","volume":"121","author":"Tsunoda A","year":"2006","journal-title":"J Laryngol Otol"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-015-3304-1"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12070-016-1040-y"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.21354"}],"container-title":["The Laryngoscope"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Flary.27506","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/lary.27506","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,14]],"date-time":"2023-09-14T16:29:47Z","timestamp":1694708987000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/lary.27506"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,10,16]]},"references-count":14,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2019,2]]}},"alternative-id":["10.1002\/lary.27506"],"URL":"https:\/\/doi.org\/10.1002\/lary.27506","archive":["Portico"],"relation":{},"ISSN":["0023-852X","1531-4995"],"issn-type":[{"value":"0023-852X","type":"print"},{"value":"1531-4995","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,10,16]]},"assertion":[{"value":"2018-07-18","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-10-16","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}