Maurice Barancik, MDRockford Clinic, Ltd.

2300 North Rockton AvenueRockford, Illinois 61103

A new protective mouthpiece for use withfiberendoscopes

The increased availability of fiberoptic endoscopes hasmeant that clinicians have come to rely on information ob­tained by their use.' Unfortunately, these instruments areexpensive and easily damaged, repairs are costly, and fewunits can afford to have duplicate instruments in order tomaintain a continuous service when repairs are necessary.Probably the commonest extrinsic danger is damage by aconfused or inadequately sedated patient biting theinstrument.' Moreover, the endoscopist risks having hisfingers bitten during intubation.

The plastic guard provided with some instruments hasproved inadequate for a number of reasons. It has a smallflange and is thus difficult to keep firmly between the teeth, asthere is no means of securing it in position. It is easy for thepatient to spit it out or to displace it with his tongue sufficientlyto expose the instrument to the teeth. The opening throughwhich the instrument is threaded is small, and there is somedifficulty in maneuvering the instrument particularly if theguard ti Its in the patient's mouth, as often happens. Theseinadequecies discouraged us and others we know from usingthe guard, thus exposing instruments and fingers to risk.

We have devised a mouthpiece which overcomes theabove disadvantages, is cheap and easy to make, and is easy touse.

The mouthpiece. The mouthpiece (see illustration) wasfashioned from acrylic resin (n Acron" denture base; heatcuring) by our dental workshop. Its overall size is about 12 cmx 5 cm. The flange is curved to the contour of the face. Thecentral channel through which the instrument is passed is atube 3.5 cm long, with an internal diameter of 2.3 cm. Thetube protrudes well into the buccal cavity, past the toothmargins, and is directed backward and a little downward toallow for the angulation of the soft palate and for easy passageof the instrument. The smaller holes in the flange, on each sideof the central channel, are used for suction of the mouth andpharynx when the mouthpiece is in position. The mouthpieceis kept in position by an anesthetic mask rubber harness(Anesthetic mask rubber headband9 BOC Ref:373185). Stain­less steel hooks are embedded into the flange to engage on theloops of the harness. The upper margin ofthe flange is notchedto allow it to fit under the nose.

Method of use. The mouthpiece is threaded over the instru­ment, and the instrument may be passed in the usual way.Once the esophagus is intubated, the mouthpiece is wedgedbetween the teeth and secured by the rubber harness.

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An improved lens irrigation system forthe ACMI fiberpanendoscope

A bothersome feature of the ACMI fiberpanendoscope hasbeen its awkward lens irrigation system. Unlike the automatedOlympus push-button irrigation, the ACMI system employs adependent syringe fi lied with water and connected to theirrigating channel by plastic connecting tubing.

One must frequently remove the right hand from the controlhandle to activate the syringe. The syringe will frequently twistaround the instrument table in an annoying way. These prob­lems are obviated by employing a foot activated surgicalsoap-type dispenser attached to a stand and connected by along plastic tube to the instrument irrigating channel. Theplastic tube is taped out of the way to the instrument cable (seeillustration).

The system utilizes components readily available in anyhospital. It can be set up in a short time. A few rapid footmotions promptly clean the lens with a 3 ml bolus of water towhich Mylicon may be added. Dead space in the tubing maybe eliminated by keeping the water level in the dispenserslightly higher than the 'scope. If too high or too low, thenwater may either run into or from the 'scope when the footmechanism is not being pumped.

This system is operational at the Rockford Memorial Hospi­tal Gastrointestinal Laboratory and works well. Panendoscopyand colonoscopy become remarkably unencumbered withthis system.

VOLUME 23, NO.2, 1976 101