Advancements in ENT surgery from sword swallowing to panendoscopy

Panendoscopy is a common ENT procedure that is performed to visualise the pharynx, larynx and oesophagus. The use of endoscopy has become very popular among surgical specialities. Antonin Desormeaux, also known as the “father of endoscopy” was the first clinician who produced the cystoscope in 1853. In 1863, Adolf Kussmaul was approached by his colleague Dr Julius Muller, who had witnessed a sword swallower in a live performance and thought he would make a good candidate for rigid oescophagoscopy. At that time, Kussmaul was a very successful physician, and a Professor of Medicine. He was the first to describe progressive bulbar palsy and polyarteritis nodusa. He also made significant advancements in clinical medicine including Kussmaul sign, Kussmaul breathing and Kussmaul coma. Kussmaul began working with the sword swallower and observed his technique closely. He then developed a 47cm long tube, with mirrors and a gasoline lamp to use. Kussmaul performed the first esophagoscopy on the sword swallower in 1868, however, he was disappointed as the view was obscured by gastric secretions and inadequate lighting. He never published a case report. Years later, he was approached by the Mikulicz-Leiter team for advise as they went on to further improve his design and produce the first successful oesophagoscope. A hundred years later, Oskar Kleinsasser developed the microlaryngoscope, which allowed direct visualisation the larynx, and now has become one of the most common ENT procedures