Tracheoscope: an old instrument with new applications.

The tracheoscope is a bronchoscope without the side ventilating ports at the distal tip. It has been used for decades, implementing diagnostic and therapeutic procedures in the subglottis and cervical and thoracic trachea. The closed tube tracheoscope allows excellent control of the airway with maintenance of continuous anesthesia and ventilation. Flexible fiber-directed lasers, such as the potassium-titanyl phosphate laser, can be used with the tracheoscope for laser resection or vaporization of diseased tissue from just below the vocal cords to any level within the trachea. Controlled anesthesia and smoke evacuation are maintained throughout the operation, allowing a relatively safe endoscopic procedure. Disorders such as subglottic hemangioma, subglottic or tracheal webs, papillomatosis, granuloma, and a variety of neoplastic growths can be excised, debulked, or submitted to biopsy by means of this instrument. In the neonatal and infant airway, use of the tracheoscope concomitantly with rigid telescopes has been particularly rewarding.