Objective: Panendoscopy is commonly performed in patients with oral squamous cell carcinoma as a screening measure for simultaneous malignant disease. Flexible trans-nasal-laryngo-oesophagoscopy (TNO) is a technique that allows for a comprehensive examination of the upper aero-digestive tract, and potentially, a viable alternative to traditional panendoscopy. Since its introduction a decade ago; it has never been widely adopted in the UK. The most common perceived limitation of TNO is the unreliability of visualising key areas, especially pharyngo-oesophageal segment. We aimed to evaluate a teaching hospital’s experience with TNO under local anaesthetic in an outpatient setting.
Methods: Prospective study of a consecutive group of patients who attended the TNO clinic between July and October 2012. We collected demographic data, as well as information on the quality of the views obtained at various areas of the upper aero-digestive tract/oesophagus, and the duration of the procedure. Results: Sixty five patients underwent TNO during the study period. Of these, 34 were male and 31 female. The average age was 59 years old (range 27–90). The primary indication for TNO in this group was ‘Globus’ symptomatology. All patients tolerated the procedure. The frequency of good quality of views included: nasopharynx/oropharynx 100% ( n = 65), larynx 100% ( n = 65), hypo-pharynx/post-cricoid area 94% ( n = 61), body of the oesophagus 94% ( n = 61) and gastro-oesophageal junction 91% ( n = 59). Data pertaining to procedure times were available for 51 subjects. The majority of the TNOs were completed in under 5 min (mean 2.1 min, standard deviation 54 s). There were no documented complications.
Conclusion: Outpatient TNO is well tolerated. Good quality views of the upper aero-digestive tract were obtained in excess of 90% of patients. TNO has a role in the screening of patients with head and neck malignancy and deserves a place in the armamentarium of the maxillofacial oncological surgeon.