Comparing Miller and Macintosh laryngoscope for Removing Foreign body from hypopharynx by Magill forceps

Aims and Esophageal foreign body can be harmful. Esophagoscopy is the most common method of foreign body extraction. But in many cases during laryngoscopy the foreign body is visible in hypopharynx region and anesthesiologist can remove it with a Magill forceps. In these cases laryngoscopy should give an appropriate and sufficient view from hypopharynx. The aim of this study was to compare two common laryngoscopy blades including Miller and Macintosh in producing direct view of hypopharynx and the possibility of foreign body removal, in order to present the preferred method. Methods and Materials: After performing lateral and anteroposterior neck radiography for confirming foreign body existence above the 7th cervical spine, patients over 10 years old with history of swallowed foreign body and candidate for esophagoscopy, were included in this study. Randomly one of the Miller and Macintosh blades was chosen and after induction of anesthesia and laryngoscopy the grade of hypopharynx view was recorded. In this grading system created by author, increasing grade of hypopharynx was associated with better view of hypopharyngeal inlet and more possibility of visualizing and removing foreign body. After laryngoscopy and in case of visualizing, attempt to remove the foreign body by Magill forceps was done. In 60 patients, with similar BMI and Demographic data, the Grade 4 of hypopharyngeal view, creating a better view for the removing foreign bodies, was approximately 3 times more common in Macintosh group than Miller one (56.% vs. 20%).In grade 4 of hypophangeal view the success rate of Macintosh blade was (94.1%) and for Miller it was(50%)(P value:0.04).Overall, the success rate of Macintosh blade in all grades was 4.3 times more than Miller blade. Comparing laryngeal view and success rate of two laryngoscopes (Macintosh and Miller) showed that grade 4 of laryngoscopy, which seems to be more appropriate for removing foreign body, is more common in Macintosh group than the other one. Regarding the success rate, we observed that Macintosh blade had a higher chance of removing foreign body. In general, the success rate of the Macintosh laryngoscope was more than Miller.