Rose Position for Microlaryngeal Surgery
The "rose position" is not a recognized or standard positioning technique for microlaryngeal surgery, and there is no evidence supporting its use in the medical literature or clinical guidelines for laryngeal procedures.
Standard Positioning for Microlaryngeal Surgery
The established approach to microlaryngeal surgery involves specific positioning techniques that optimize laryngeal exposure while minimizing tissue trauma:
Traditional Direct Laryngoscopy Positioning
Patients are positioned supine with neck extension and head positioning to align the oral, pharyngeal, and laryngeal axes for optimal visualization during direct suspension laryngoscopy 1.
Straight rigid laryngoscopes require bringing oropharyngeal structures into an unnatural position with considerable forces, which can lead to tissue injuries or make the procedure impossible in some cases 2.
The success of microlaryngoscopy depends on adequate laryngeal exposure, which is achieved through proper head positioning and laryngoscope selection rather than any "rose position" 2, 3.
Alternative Positioning Strategies for Difficult Exposure
When standard positioning fails to provide adequate exposure:
Curved rigid laryngoscopes can significantly reduce forces on oropharyngeal tissues compared to straight laryngoscopes while improving anterior commissure exposure 2.
Angled endoscopes (30- and 70-degree) combined with angled instruments (forceps, suction, scissors) enable complete visualization and surgical resolution in cases of difficult laryngoscopy 4.
The choice of laryngoscope design and video endoscopes may permit improvements in laryngeal exposure while minimizing insertion damage, but this relates to equipment selection rather than patient positioning 3.
Critical Positioning Considerations
Optimal positioning must balance surgical exposure with patient safety, avoiding excessive force that could cause dental injury, temporomandibular joint damage, or cervical spine complications 2.
Patients with anatomical limitations (narrow mandibular arch, large tongue, trismus, or cervical spine restrictions) may require alternative approaches including transoral robotic surgery or modified laryngoscope designs rather than alternative positioning 1.
Common Pitfalls to Avoid
Do not confuse positioning terminology - there is no established "rose position" in laryngeal surgery literature, and using non-standard terminology can lead to miscommunication in the operating room.
Excessive neck extension or improper positioning can compromise both surgical exposure and patient safety 2.
Failed laryngeal exposure should prompt consideration of alternative equipment (curved laryngoscopes, angled endoscopes) or surgical approaches rather than extreme positioning maneuvers 2, 4.