Abstract
In order to detect squamous cell carcinoma in the oropharyngeal and hypopharyngeal fields at an earlier stage, the use of a questionnaire is a practical means to identify patients with a high risk of developing neoplasia. Our screening procedure is as follows. First, the patient is asked to bow their head deeply in the left lateral position. We then put a hand on the back of the patient's head and push it forward. The patient is then asked to lift the chin as far as possible (lateral sniffing position). In order to inspect the oral cavity, we insert an endoscope without a mouthpiece and observe the upper, lateral and posterior wall of the oropharynx while the patient sticks the tongue forward. After observation of the buccal cavity, further oropharyngeal observation is carried out with a retroflexed endoscope inserted via the nose. The patient is asked to open the mouth wide, stick the tongue forward as far as possible and say “aah” during the oropharyngeal screening.
For examination of the hypopharynx and the orifice of the esophagus, the patient is asked to blow hard and puff their cheeks while the mouth remains closed. The endoscopist pulls the patient's chin forward with the right hand. The posterior wall of the hypopharynx and the postcricoid subsite are tight in most cases. The blowing technique to distend the pyriform fossae and the posterior pharyngeal wall enables the pharyngeal mucosa to be stretched out and also the postcricoid region and the orifice of the esophagus to be visualized in an open space.
Mucosal redness, a pale thickened mucosa, white deposits or loss of a normal vascular pattern are important characteristics to diagnose superficial carcinoma upon examination under white light. Also, well-demarcated areas covered with scattered dots observed upon closer observation indicates potential cancer. The use of image-enhanced endoscopy facilitates the visualization of superficial microvascular structures and allows the detection of a lesion at an earlier stage.
