Objectives: To describe patient positioning maneuvers that optimize visualization of the oropharynx during flexible endoscopyMethods:An institutional database of videos obtained from 2021 to 2023 during flexible endoscopy of patients with oropharyngeal carcinoma (OPC) was reviewed. Patients seen outside the specialty head and neck clinic, those with tonsillar primary tumors, and those only with videos of fiberoptic swallowing evaluations were excluded. A total of 10 videos were then independently analyzed by 2 reviewers to assess the effects of 4 maneuvers on oropharyngeal tumor visualization: chin elevation, phonation, tongue protrusion, and contralateral head turn. After segmentation analysis in Label Studio, total surface area (SA) of visualized tumor in pixels was calculated in Python and compared against the maximum width of the epiglottis to calculate relative SA.
Results: Four different maneuvers were evaluated in this study: (1) chin elevation [n = 4]; (2) phonation [n = 9]; (3) tongue protrusion [n = 4]; and (4) contralateral head turn [n = 9]. The maneuvers on average increased the visualization of tumor surface area(SA) compared to baseline view: contralateral turn increased SA by 1.7 fold (95% CI = 1.11-2.34), phonation increased SA by 1.7 fold (95% CI = 1.11-2.37), tongue protrusion increased SA by 1.5 fold (95% CI = 1.16-1.80), and chin elevation increased SA by an average of 2.7 fold (95% CI = 0.74-4.72).
Conclusion: Instituting simple additional positioning techniques during flexible endoscopy for patients with oropharyngeal tumors can improve visualization and staging for baseline assessment and staging.
Keywords: HPV related oropharyngeal cancer; dynamic laryngoscopy; head and neck cancer; oropharyngeal cancer; video laryngoscopy.