The Trumpet Maneuver During CT Scanning and Office Videoendoscopy

Introduction

At rest, the laryngopharynx (throat and voice box) lie closely against one another. The pharynx essentially “hugs” the laryngeal inlet. Because of this, the point of attachment of a tumor in the laryngopharynx can be difficult to define without operative endoscopy under general anesthesia. This is especially true when the tumor is highly exophytic: it may appear bulky, touching many contiguous areas, but in fact attach at only a small base. For example, a tumor with a cauliflower-like shape may abut numerous surfaces but truly arise from only one.

Clear understanding of point of attachment is important surgically. A tumor that initially looks extensive and unresectable may, once the point of attachment is clarified, prove amenable to simple endoscopic laser excision.

Concept

The trumpet maneuver takes its name from the visible throat changes when a person plays a trumpet. Back pressure generated by blowing into the trumpet mouthpiece causes distention of the laryngopharynx. The larynx now inhabits an “enlarged” throat: the pyriform sinuses expand, and the post-arytenoid and post-cricoid mucosa shift anteriorly, away from the posterior pharyngeal wall. These positional changes “open up” the pharynx, exposing hidden tumor bases.

For a dramatic visual analogy, think of jazz trumpeter Dizzy Gillespie’s cheeks and neck while playing.

Clinical Application

This principle can be applied to patients with suspected tumors of the supraglottic larynx and pharynx, especially when involving the pharyngeal walls, pyriform sinuses, epiglottis, or base of tongue. It is less helpful for tumors confined entirely within the endolarynx.

The maneuver can be employed both during office videoendoscopy and during CT scanning.

Technique

1. Preparation: Before the examination, explain the concept of “throat inflation” to the patient, including its purpose (“to see the throat better”). Demonstrate the maneuver and practice together for 30–60 seconds.
2. Lip seal: Instruct the patient to seal the lips securely around the middle joint of the index finger (or a similar object).
3. Execution: Direct the patient to blow forcefully, as if inflating a very stiff party balloon, and to sustain the effort for approximately ten seconds.
4. Application: During parts of office endoscopy or CT scanning, ask the patient to “inflate” the throat.
5. Repetition: Alternate between rest/quiet breathing and throat inflation to improve performance and provide opportunities for multiple video views or x-ray imaging passes.

Because the maneuver requires breath suspension, timing is important. A single CT pass of the neck typically takes 10–15 seconds, well within most patients’ ability to tolerate. During office endoscopy, inflations are easier to repeat and can be adjusted in length for patient comfort and until the desired views are videorecorded.