Rose Position

🌹 Rose’s Position – ENT Surgical Position Explained

Rose’s position is a commonly used surgical position in ENT, especially during oropharyngeal surgeries. It is a high yield viva and MCQ topic, frequently asked in relation to tonsillectomy and adenoidectomy.

What is Rose’s Position?

Rose’s position is a supine surgical position in which the head is extended at the atlanto occipital joint to provide optimal exposure of the oropharynx.

How is Rose’s Position attained?

• The patient is placed supine

• A sandbag or head ring is placed under the shoulders. This causes:

  • Extension of the neck
  • Slight backward tilt of the head

• The head is extended at the atlanto-occipital joint

➡️ This configuration is known as Rose’s position.

What is the purpose of Rose's Position?

Surgeries Where Rose’s Position is Used

• Tonsillectomy (most common)
• Adenoidectomy
• Uvulopalatopharyngoplasty (UPPP) for obstructive sleep apnea
• Palatal surgeries
  • Cleft palate repair
  • Pharyngoplasty
• Oropharyngeal tumor excision
• Base of tongue surgeries
• Oral cavity tumor resection
• Foreign body removal from oropharynx
• Microlaryngeal surgeries

What are the Precautions you should take while Using Rose’s Position?

Contraindications of Rose’s Position

1️⃣ Cervical Spine Instability or Trauma

• Atlantoaxial dislocation
• Cervical spine injury
• Rheumatoid arthritis
  ➡️ Risk of spinal cord injury

2️⃣ Congenital Cervical Spine Anomalies

• Down syndrome (atlantoaxial instability) - ⚠️ Very important MCQ point

3️⃣ Severe Kyphosis or Spinal Deformities

• Neck extension may not be possible or safe

4️⃣ Severe Obstructive Sleep Apnea

• Excessive neck extension can worsen airway obstruction under anesthesia

5️⃣ Raised Intracranial Pressure

• Neck extension → venous congestion
• Can worsen cerebral edema

📌 Key Exam Points

• Extension occurs at atlanto-occipital joint

• Used mainly for oropharyngeal surgeries

• Down syndrome is a classic contraindication (Important MCQ)