Preoperative clinical predictors of difficult laryngeal exposure for microlaryngoscopy: the Laryngoscore.

Abstract

OBJECTIVES/HYPOTHESIS:

To identify a clinical predictor score for difficult laryngeal exposure (DLE) during operative microlaryngoscopy.

STUDY DESIGN:

Prospective cohort study in two academic institutions.

METHODS:

We evaluated 319 patients before microlaryngoscopy for benign and malignant glottic diseases by a standardized preoperative assessment protocol (Laryngoscore) that included 11 parameters: interincisors gap (IIG), thyro-mental distance, upper jaw dental status, trismus, mandibular prognathism, macroglossia, micrognathia, degree of neck flexion-extension, history of previous open-neck and/or radiotherapy, Mallampati's modified score, and body mass index (BMI). Each parameter was assessed to obtain a total score. Patients were divided into five classes according to the anterior commissure (AC) visualization: class 0, complete AC visualization with large-bore laryngoscopes in the Boyce-Jackson position; class I, as class 0 with external laryngeal counterpressure; class II, as class I in the flexion-flexion position; class III, as class II using small-bore laryngoscopes; and class IV, impossible AC visualization.

RESULTS:

Class 0-I-II (good/acceptable laryngeal exposure) presented a median score < 6. This value was chosen as cutoff for distinguishing favorable versus difficult/impossible laryngeal exposures. When the Laryngoscore was < 6, good laryngeal exposure was observed in 94% of patients, whereas when ≥ 6, DLE was encountered in 40%. When considering a Laryngoscore of ≥ 9, 67% of patients had a DLE. At univariate analysis, IIG, upper jaw dental status, macroglossia, micrognathia, degree of neck flexion-extension, and BMI statistically impacted on DLE (P < 0.05).

CONCLUSIONS:

The Laryngoscore is a good predictor of DLE and assists in selecting the ideal candidates for operative microlaryngoscopy.

LEVEL OF EVIDENCE:

2b.

• Authors: Cesare Piazza, Stefano Mangili, Francesca Del Bon, Alberto Paderno, Paola Grazioli, Diego Barbieri, Pietro Perotti, Sabrina Garofolo, Piero Nicolai, Giorgio Peretti
• Journal: The Laryngoscope (Laryngoscope) Vol. 124 Issue 11 Pg. 2561-7 (Nov 2014) ISSN: 1531-4995 [Electronic] United States
• PMID: 24964904 (Publication Type: Comparative Study, Journal Article, Multicenter Study)
• Copyright: © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

Topics

• Academic Medical Centers
• Adult
• Aged
• Analysis of Variance
• Cohort Studies
• Equipment Design
• Female
• Glottis (surgery)
• Humans
• Italy
• Laryngeal Diseases (diagnosis, surgery)
• Laryngoscopes
• Laryngoscopy (methods)
• Larynx (abnormalities, surgery)
• Male
• Microsurgery (methods)
• Middle Aged
• Natural Orifice Endoscopic Surgery (instrumentation, methods)
• Patient Positioning
• Predictive Value of Tests
• Preoperative Care (methods)
• Prospective Studies
• Reproducibility of Results