Chin up, doc! A few simple manoeuvres could make all the difference in FNE
Reviewed by Thomas William Binnersley

Flexible nasendoscopy (FNE) is an ENT surgeon’s bread and butter. It is integral and often considered superior to conventional radiography in the assessment of laryngeal and pharyngeal cancers. However, it is not as simple as sticking the camera in and snapping a quick picture. The operator must rely on a Hokey-Cokey of manoeuvres to allow for adequate visualisation of the tumour’s extent and to spot those naughty nodules that like to hang out in the piriform fossae. Rahman and colleagues claim to be the first to evaluate a set of manoeuvres specifically optimised to visualise cancers of the oropharynx: 1. Tongue protrusion; 2. Sustained ‘e’ during phonation; 3. Chin elevation; 4. Contralateral neck turn. To assess the visual benefit of each manoeuvre, they reviewed 10 FNE videos of oropharyngeal tumours and compared the total visible surface area on the baseline oropharyngeal view with that on each manoeuvre. The data demonstrate a 1.5- to 2.7-fold increase in tumour surface area visualisation, although the study’s small sample size precluded a statistically significant result. Data from a larger cohort is certainly needed to power the study sufficiently for potential mainstream implementation of their manoeuvres. Despite this, this paper serves as a helpful guide to those less confident in oropharyngeal examination. I particularly enjoyed the authors’ anatomical and functional justification of each manoeuvre in the discussion. With further validation, this could well become a recognised addition to the ENT diagnostic toolkit.

Improved Visualization of Oropharyngeal Tumors Using Simple Maneuvers During Flexible Endoscopy.
Rahman AS, Wang VJ, Paderno A, et al.
ANN OTOL RHINOL LARYNGOL
2025;134(5):361–5.