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Probably the second most common endoscopic procedure is the oral approach to examine the trachea and syrinx for disease, esp. syringeal infections. Parrots that suddenly lose their voice and present in acute respiratory distress are first stabilized using an air sac tube (placed using the same approach as for left sided endoscopy described above) to provide an alternative airway. The bird can then be anesthetized with isoflurane or sevoflurane via this air sac tube leaving the mouth clear for tracheoscopy, biopsy and debridement. In larger birds the exam/protection sheath should be used (OD 3.5mm) and will enable tracheoscopy of birds over 400g (e.g. Amazons, African grays, macaws and cockatoos). In smaller birds, either use a 1.0mm semi-rigid endoscope, 1.9mm telescope, or unsheathed (unprotected) 2.7mm telescope. It is vital that when using any unsheathed (unprotected) telescope that the bird's head and neck are kept extended and straight, and that the endoscopist does not exert any bend or torque on the scope, otherwise fracture of the glass rods will occur.

Tracheoscopy in an African gray parrot.
Tracheoscopy in an African gray parrot in sternal recumbency using an unsheathed (unprotected) 2.7mm telescope. Note that the parrots' head and neck are extended, and air sac intubation has been employed to maintain anesthesia.

Mycotic granuloma occluding the entire distal trachea of a cockatoo.
Mycotic granuloma occluding the entire distal trachea of a cockatoo. The biopsy forceps are being advanced to biopsy and debride the lesion while anesthesia is maintained via an air sac tube.

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