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To the Editor:—
I think that I have found a method of placing a gastric feeding or decompression tube that is safe, easy, fast, comfortable, and simple.It consists of blindly passing a nasogastric tube through the pyriform sinus from inside out. I do this by pushing a large curved Péan's forceps into the right sinus, pushing it anteriorly to tent up the skin, making a small knife hole in the skin over the tip, and pushing the point through the hole from the inside out. Until you have done this operation you cannot understand just how thin the pharyngeal wall is at this place. The skin hole should be so small that the tube occludes it.The pyriform sinus is located at the side of the larynx below the glottis, medial to the carotid sheath and above the thyroid. Only the pharyngeal mucosa, the pharyngeal aponeurosis, and the skin
Ritter JA. Pyriform Sinusostomy. JAMA. 1969;207(2):367–368. doi:10.1001/jama.1969.03150150079029