13 Oropharynx

280 Oropharynx

Fig. 4D (continued): AP view with Iridium wires

After palpation of the position of the hyoid bone and the carotid artery, the entrance points of the needles are marked on the skin. The anterior loop will enter 10 mm above the hyoid and will pass through the anterior faucial pillar. The entrance point of the posterior loop is marked 10 mm beneath the hyoid and will pass through the posterior pillar (Fig 12.5).

Fig 12.5 : Pernot technique for implanting the faucial arch: skin entrance points of posterior pillar and palatal free border. Anterior pillar and border soft or hard palate.

The posterior tube is positioned first. A 10 cm guide needle is introduced under the hyoid bone perpendicularly to the skin and is then advanced posteriorly about 25 mm into the neck, towards the pharyngeal mucosa, guided by a palpating finger in the oropharynx. Then the needle is turned cranially, and it is gently manoeuvred through the tissues and along the posterior faucial pillar to emerge in the oropharyngeal cavity at the junction of the inferior border of the soft palate and the posterior faucial pillar. A strong nylon thread is pushed through the lumen of the needle, the needle is removed, and a 30 - 40 cm plastic tube is threaded along the nylon guide. The both are clamped together and pulled into position by gentle traction on the oropharyngeal end of the nylon thread. A Reverdin hook is inserted at the junction of the inferior border of the soft palate and the left posterior faucial pillar, and it is manoeuvred along the free border until it penetrates the oropharyngeal cavity at the same point as the plastic tube. The nylon thread is grasped with the Reverdin and pulled through the free border of soft palate. The plastic tube, still coupled to the nylon thread, is then pulled into position. The two are unclamped and the nylon thread is withdrawn from the lumen of the tube. Curved hollow needles, fixed to a Boomerang device as used for bladder implantation (see that chapter) may also be used.