The 70-degree telescope as a teaching tool for cleft palate repair and pharyngoplasty surgery.

OBJECTIVE

To determine the optimum positioning of a 70-degree telescope to provide a maximum view of the palate and posterior pharynx for observers while minimally obstructing the direct view of a surgeon.

DESIGN

Simulator testing of clinical protocol.

SETTING

Simulation center of an academic tertiary care children's hospital.

INTERVENTIONS: The palate and pharynx of an infant airway mannequin was exposed with a Dingman mouthgag. A 4 mm, 70-degree endoscope was secured to the Mayo stand to provide a projected image of the simulated operative procedure. Various positions of the 70-degree telescope were photodocumented by manipulating the angle of the scope, the extension past the lower lip, and the distance of the scope tip away from the midline. Using a 4-point Likert scale, three surgeons rated the randomized photos from both the direct operative view and the projected endoscopic view.

RESULTS

Average rating for the adequacy of the view for pharyngeal surgery was 2.4/4.0 and for palate surgery was 3.1/4.0 (p=.001). Only 4 of 22 scope positions were rated as minimally obstructive to direct view by all three surgeons. Only 1 position--scope parallel and just lateral to the tongue blade--was rated as minimally obstructive and adequate for both pharyngeal and palatal surgery by all three surgeons.

CONCLUSIONS

In training centers, a 70-degree telescope attached to a Mayo stand may be useful for teaching and assessing cleft palate and pharyngoplasty surgery, while providing minimal obstruction to direct view by the surgeon.