Problems that should be noted in laryngoscopy in the diagnosis of laryngeal cancer

Issues that should be noted in indirect laryngoscopy and biopsy of laryngeal cancer:

(1) During the examination, all parts of the larynx must be clearly seen. If the epiglottis is tilted backward and the anterior commissure cannot be seen clearly, the epiglottis can be retracted forward with an epiglottic hook or a laryngeal cotton ball under topical anesthesia. Electronic laryngoscope or fiberoptic laryngoscope examination should be performed for patients with obesity, short and thick neck, limited mouth opening, short and thick tongue, and strong pharyngeal reflex.

(2) During laryngoscopy, one should develop the habit of observing the anatomy of each part from the outside to the inside, from the shallow to the deep, in sequence. During laryngoscopy, attention should be paid to whether the movement of the vocal cords is restricted or fixed, whether the pyriform sinuses on both sides are symmetrical, whether one side is full and has secretion retention, etc.

(3) During biopsy, the central part of the tumor should be taken with forceps, and care should be taken not to take it too shallowly or on the ulcerated surface of the tumor. Patients with suspicious clinical symptoms but negative biopsy need to undergo repeated biopsies. If the patient has difficulty breathing, the biopsy should be performed after tracheotomy.

(4) The observation of pathological morphology is closely related to the sampling site and technique of the clinical physician. The pathologist can only see a very limited specimen. Clinical pathological diagnosis of carcinoma in situ should be cautious. Pathological biopsy is a test of a sample and often does not represent the entire picture of the patient's lesion.