Bronchoscopy and Esophagoscopy | Page 8

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. The stretching is here produced by the spring of the blades of the forceps and not by manual force. The closed blades are to be inserted through the strictured area, opened, and then slowly withdrawn. For cicatricial stenoses of the trachea the metallic bougies, Fig. 40, are useful. For the larynx, those shown in Fig. 41 are needed.
[FIG. 34.--A, Mosher's laryngeal curette; B, author's flat blade cautery electrode; C, pointed cautery electrode; D, laryngeal knife. The electrodes are insulated with hard-rubber vulcanized onto the conducting wires.]
[FIG. 35.--Retrograde esophageal bougies in graduated sizes devised by Dr. Gabriel Tucker and the author for dilatation of cicatricial esophageal stenosis. They are drawn upward by an endless swallowed string, and are therefore only to be used in gastrostomized cases.]
[FIG. 36.--Author's bronchoscopic and esophagoscopic mechanical spoon, made in 40, 50 and 60 cm. lengths.]
[FIG. 37.--Schema illustrating the author's method of endoscopic closure of open safety pins lodged point