Figure 42-27 A, Superior laryngeal nerve block can be accomplished without injection by applying 4% lidocaine into each piriform fossa with a sponge or pledget mounted on Krause angle forceps. B, Similar application can be accomplished with the flexible laryngotracheal mucosal atomization device (MADgic, Wolfe Tory Medical, Inc., Salt Lake City, UT) by placing 3 to 4 mL of 4% lidocaine in each piriform fossa.