DIFFICULT LARYNGOSCOPY MADE EASY WITH A BURP

Displacement of the larynx by backward, upward and rightward pressure on the thyroid cartilage or ''BURP'' may improve visualization of the glottis in some cases of difficult direct laryngoscopy In a patient with the Treacher-Collins syndrome in whom conventional laryngoscopy had proved impossible and tracheal intubation extremely difficult, this manoeuvre exposed the entire glottis and made tracheal intubation under direct vision easy. In a patient with protruding upper incisors and a prominent premaxilla which precluded a view of the glottis by conventional laryngoscopy, ''BURP'' again revealed the glottic opening and simplified the placement of an endotracheal tube. This experience suggests that ''BURP'' be considered as a potential aid in the management of difficult direct laryngoscopy.