Suspension laryngoscopy revisited.

Every critical advancement in direct laryngoscopic surgical technique has enhanced its precision. Among the most notable was Killian's seminal description of suspension laryngoscopy 90 years ago, which allowed for bimanual direct laryngoscopic surgery. Because of the technical difficulties encountered while performing suspension laryngoscopy, Brünings and Seiffert designed fulcrum laryngoscope holder-stabilizers for spatula laryngoscopes from Killian's original instrument design. Their devices, which were easier to use and better tolerated by patients, were supported from the laryngeal cartilage framework or chest wall. Laryngoscope holder-stabilizers were retrofitted to tubular laryngoscope specula in the 1940s and 1950s, whereupon they became very popular. Suspension laryngoscopy should have become more common subsequent to the introduction of general endotracheal anesthesia with paralysis in the 1960s. However, laryngoscope holder-stabilizers were entrenched as the device preferred by most, and they remain so today. This entrenchment occurred despite the fact that suspension laryngoscopy allows for positioning a larger examining speculum, which in turn allows for enhanced exposure and endolaryngeal procedural precision. The applied vector forces on the mandible, maxilla, oral cavity, pharynx, and larynx associated with suspension laryngoscopy are preferable to those associated with holder-stabilizers. A prospective assessment of 120 cases revealed effective use of suspension laryngoscopy in all. We believe that only a minority of surgeons has actually seen true suspension laryngoscopy and that its merits are worthy of reexamination.