Vocal fold exposure in phonosurgery.

A difficult laryngeal exposure is made easier by placement of the patient's head and neck into the Boyce-Jackson "sniffing position" and then flexing them further if necessary, by selection of a laryngoscope appropriate to the patient and to the triangular glottic shape, by placement of the laryngoscope along the path of least resistance, by use of a true suspension device in order to apply the force for laryngoscopy towards the larynx and away from the teeth and gums, and by allowing time for the force to work. With these techniques, an easy exposure is made almost perfect. The true vocal folds are exposed from vocal process to anterior commissure without the need for external pressure, the endotracheal tube remains out of sight between the arytenoids, and there is no risk to the teeth, gums, and cervical spine.