Universal modular glottiscope system: The evolution of a century of designand technique for direct laryngoscopy

Since Kirstein introduced formal direct examination (autoscopy) of the glot tis in 1895, a great number of laryngoscopes have been produced to view the vocal folds; however, none have had universal appeal. The primary goals fo r the designs have been to optimize exposure and to facilitate instrumentat ion of the glottis. An analysis of more than 50 laryngoscopes was done to a ssess key design characteristics that would ideally be present in a laryngo scope for optimally viewing the musculomembranous vocal folds. The Pro/Engi neer and Pro/Mechanica computer programs were used to model the universal m odular glottiscope. This new laryngoscope comprises a plurality of speciall y designed examining tubes that are bivalved proximally to improve utilizat ion of hand instrumentation, and form a single tube distally to achieve int ernal distention of the supraglottal tissues. The distal lumen has an arcua te isosceles-triangular conformation to optimally expose the glottis. The b ase of the tube is detachable for the difficult intubation or the placement of bronchoscopes. The examining tubes vary in size and dimension to accomm odate the diversity of human anatomy. The tubes are easily attachable to an d detachable from an ergodynamically designed universal handle that can be joined to fulcrum laryngoscope holders or suspension gallows. The universal modular glottiscope evolved from the selective integration of optimal 20th -century design modifications of Kirstein's original autoscope. This new la ryngoscope is ideally suited for phonomicro-surgery as well as for difficul t intubation.