Bronchoscopy and Esophagoscopy | Page 8

below the cricopharyngeus.]
[FIG. 23.--Expansile forceps for the endoscopic removal of hollow
foreign bodies such as intubation tubes, tracheal cannulae, caps, and
cartridge shells.]
Screw forceps.--For the secure grasp of screws the jaws devised by Dr.

Tucker for tacks and pins are excellent (Fig. 21).
Expanding Forceps.--Hollow objects may require expanding forceps as
shown in Fig. 23. In using them it is necessary to be certain that the
jaws are inside the hollow body before expanding them and making
traction. Otherwise severe, even fatal, trauma may be inflicted.
[FIG. 24.--The author's fenestrated peanut forceps. The delicate
construction with long, springy and fenestrated jaws give in gentle
hands a maximum security with a minimum of crushing tendency.]
[FIG. 25--The author's bronchial dilators, useful for dilating strictures
above foreign bodies. The smaller size, shown at the right is also useful
as an expanding forceps for removing intubation tubes, and other
hollow objects. The larger size will go over the shaft of a tack.]
[FIG. 26.--The author's self-expanding bronchial dilator. The extent of
expansion can be limited by the sense of touch or by an adjustable
checking mechanism on the handle. The author frequently used smooth
forceps for this purpose, and found them so efficient that this dilator
was devised. The edges of forceps jaws are likely to scratch the
epithelium. Occasionally the instrument is useful in the esophagus; but
it is not very safe, unless used with the utmost caution.]
Tissue Forceps.--With the forceps illustrated in Fig. 28 specimens of
tissue may be removed for biopsy from the lower air and food passages
with ease and certainty. They have a cross in the outer blade which
holds the specimen removed. The action is very delicate, there being no
springs, and the sense of touch imparted is often of great aid in the
diagnosis.
[FIG. 27.--The author's upper-lobe bronchus forceps. At A is shown the
full-curved form, for reaching into the ascending branches of the
upper-lobe bronchus A number of different forms of jaws are made in
this kind of forceps. Only 2 are shown.]
[FIG 28--The author's endoscopic tissue forceps. The laryngeal length
is 30 cm. For esophageal use they are made 50 and 60 cm. long. These

are the best forceps for cutting out small specimens of tissue for
biopsy.]
The large basket punch forceps shown in Fig. 33 are useful in removing
larger growths or specimens of tissue from the pharynx or larynx. A
portion or the whole of the epiglottis may be easily and quickly
removed with these forceps, the laryngoscope introduced along the
dorsum of the tongue into the glossoepiglottic recess, bringing the
whole epiglottis into view. The forceps may be introduced through the
laryngoscope or alongside the tube. In the latter method a greater lateral
action of the forceps is obtainable, the tube being used for vision only.
These forceps are 30 cm. long and are made in two sizes; one with the
punch of the largest size that can be passed through the adult
laryngoscope, and a smaller one for use through the
anterior-commissure laryngoscope and the child's size laryngoscope.
[FIG. 29.--The author's papilloma forceps. The broad blunt nose will
scalp off the growths without any injury to the normal basal tissues.
Voice-destroying and stenosing trauma are thus easily avoided.]
[FIG. 30.--The author's short mechanical spoon (30 cm. long).]
Papilloma Forceps.--Papillomata do not infiltrate; but superficial
repullulations in many cases require repeated removals. If the basal
tissues are traumatized, an impaired or ruined voice will result. The
author designed these forceps (Fig. 29) to scalp off the growths without
injury to the normal tissues.
[FIG. 31.--The author's laryngeal rotation forceps.]
[FIG. 32.--Enlarged view of the jaws of the author's vocal-nodule
forceps. Larger cups are made for other purposes but these tiny cups
permit of that extreme delicacy required in the excision of the nodules
from the vocal cords of singers and other voice users.]
[FIG 33.-Extra large laryngeal tissue forceps. 30 cm. long, for
removing entire growths or large specimens of tissue. A smaller size is
made.]

Bronchial Dilators.--It is not uncommon to find a stricture of the
bronchus superjacent to a foreign body that has been in situ for a period
of months. In order to remove the foreign body, this stricture must be
dilated, and for this the bronchial dilator shown in Fig. 25 was devised.
The channel in each blade allows the closed dilator to be pushed down
over the presenting point of such bodies as tacks, after which the blades
are opened and the stricture stretched. A small and a large size are
made. For enlarging the bronchial narrowing associated with
pulmonary abscess and sometimes found above a bronchiectatic or
foreign body cavity, the expanding dilator shown in Fig. 26 is perhaps
less apt to cause injury than ordinary forceps used in the same way.