Bullard laryngoscopy for tracheal intubation of patients with cervical spine pathology.

To the Editor: We would like to report the use of fibreoptic endoscopy as a method for evaluating vocal cord function following surgical procedures that could injure their innervation. A 45-yr-old woman underwent resection of the thyroid isthmus and right thyroid lobectomy. Anaesthesia and surgery were uneventful but the surgeon requested that vocal cord function be evaluated laryngoscopically during extubation. Towards the end of surgery the patient was allowed to breathe spontaneously, and the anaesthesia was supplemented with 6 mg of morphine. An Olympus LF1 endoscope (Olympus Medical Products, 8370 Dow Cr. Strongsville, OH 44136) was introduced nasally and directed toward the posterior fornix of the vocal cords. The vocal cords were examined with the endotracheal (ET) tube in place and bilateral movement was noted. Then, the cuff of the ET tube was deflated, and the tube was withdrawn past the cords. The area was inspected via the endoscope, and the vocal cords were seen to be in the normal position and moved with respiration. We then elected to remove the ET tube and finished the anaesthesia with mask ventilation. However, the ET could have been advanced into position after the examination. Postoperatively, there were no complications. We feel that fibreoptic endoscopy is a simple, quick way to evaluate the vocal cords without subjecting the patient to an additional laryngoscopy with its potential risks and discomfort.