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Intubation is normally facilitated by using a conventional laryngoscope, flexible fiberoptic bronchoscope, or video laryngoscope to identify the vocal cords and pass the tube between them into the trachea instead of into the esophagus. Other devices and techniques may be used alternatively.
Intubation granuloma is a benign growth of granulation tissue in the larynx or trachea, which arises from tissue trauma due to endotracheal intubation. [1] This medical condition is described as a common late complication of tracheal intubation, specifically caused by irritation to the mucosal tissue of the airway during insertion or removal of the patient's intubation tube.
In patients with known difficult airways, fiberoptic intubation can be considered. This technique involves the use of a flexible fiberoptic bronchoscope for visualization of the vocal cords. The bronchoscope can be passed directly into the trachea and the endotracheal tube can be threaded over the bronchoscope into position.
Optical coherence tomography (OCT) can help observe the progression of the injury. Esophageal pH monitoring can help detect any acid reflux, which can worsen the condition. A laryngoscopy or an endoscope can be inserted and used to see the vocal cords, airway, and esophagus/trachea. Spirometry is a useful way to measure respiratory function.
Indirect laryngoscopy is performed whenever the provider visualizes the patient's vocal cords by a means other than obtaining a direct line of sight (e.g. a mirror). For the purpose of intubation, this is facilitated by fiberoptic bronchoscopes, video laryngoscopes, fiberoptic stylets and mirror or prism optically enhanced laryngoscopes.
Besides the risks associated with the drugs used, there are also specific risks of the procedure. Although a rigid bronchoscope can scratch or tear airways or damage the vocal cords, the risk of bronchoscopy is limited in otherwise well patients.
"We’re shooting your vocal cords, we’re shooting your throat; where you eat, where you swallow, where you talk, breathe, everything goes through here," said Olmos pointing to his throat.
The valleculae can collect saliva to prevent initiation of the swallowing reflex. The vallecula is an important reference landmark used during intubation of the trachea. The procedure requires the blade-tip of a Macintosh-style laryngoscope to be placed as far as possible into the vallecula in order to facilitate directly visualizing the glottis .