The 70-degree telescope as a teaching tool for cleft palate repair and pharyngoplasty surgery.

OBJECTIVE: To determine the optimum positioning of a 70-degree telescope to provide a maximum view of the palate and posterior pharynx for observers while minimally obstructing the direct view of a surgeon. DESIGN: Simulator testing of clinical protocol. SETTING: Simulation center of an academic tertiary care children's hospital. INTERVENTIONS: The palate and pharynx of an infant airway mannequin was exposed with a Dingman mouthgag. A 4 mm, 70-degree endoscope was secured to the Mayo stand to provide a projected image of the simulated operative procedure. Various positions of the 70-degree telescope were photodocumented by manipulating the angle of the scope, the extension past the lower lip, and the distance of the scope tip away from the midline. Using a 4-point Likert scale, three surgeons rated the randomized photos from both the direct operative view and the projected endoscopic view. RESULTS: Average rating for the adequacy of the view for pharyngeal surgery was 2.4/4.0 and for palate surgery was 3.1/4.0 (p=.001). Only 4 of 22 scope positions were rated as minimally obstructive to direct view by all three surgeons. Only 1 position--scope parallel and just lateral to the tongue blade--was rated as minimally obstructive and adequate for both pharyngeal and palatal surgery by all three surgeons. CONCLUSIONS: In training centers, a 70-degree telescope attached to a Mayo stand may be useful for teaching and assessing cleft palate and pharyngoplasty surgery, while providing minimal obstruction to direct view by the surgeon.