Send correspondence to Francesca Boscolo Nata, MD, ENT Clinic, Head and Neck Department, Azienda Sanitaria Universitaria Integrata di Trieste, Strada di Fiume 447, 34149, Trieste, Italy. E-mail: [email protected]Search for more papers by this author

Giancarlo Tirelli MD,

Giancarlo Tirelli MD

ENT Clinic, Head and Neck Department, Trieste, Italy

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Annalisa Gatto MD,

Annalisa Gatto MD

ENT Clinic, Head and Neck Department, Trieste, Italy

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Alfonso Fortunati MD,

Alfonso Fortunati MD

ENT Clinic, Head and Neck Department, Trieste, Italy

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Riccardo Marzolino MD,

Riccardo Marzolino MD

ENT Clinic, Head and Neck Department, Trieste, Italy

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Fabiola Giudici BAM,

Fabiola Giudici BAM

Biostatistics Unit–Department of Medical, Surgical and Health Science, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy

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Francesca Boscolo Nata MD,

Corresponding Author

Francesca Boscolo Nata MD

[email protected]

ENT Clinic, Head and Neck Department, Trieste, Italy

First published: 03 December 2018

https://doi.org/10.1002/lary.27683

Citations: 21

The authors have no funding, financial relationships, or conflicts of interest to disclose.

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Abstract

Objectives

Optimal laryngeal exposure during transoral laryngeal surgery is fundamental. We aimed to evaluate the reliability of a recently proposed score (Laryngoscore) in predicting difficult laryngeal exposure (DLE) in an independent cohort of patients undergoing elective microlaryngoscopy. We also verified the relation between DLE, surgeon's expertise, and difficult intubation, and investigated possible areas for score improvement.

Study Design

Prospective validation study.

Methods

A total of 136 patients were preoperatively evaluated using the Laryngoscore. Patients were divided into three classes according to patient position, type of laryngoscope, and need for external counterpressure to expose the anterior commissure. Based on their mean scores, two groups were identified: good laryngeal exposure (GLE) and DLE. A receiver operating characteristic curve with the Youden index was used to calculate the optimal cutoff value. The χ² and Fisher exact test were used to correlate GLE and DLE to the surgeon's expertise and difficult intubation. The intraoperative anatomical parameters underlying DLE were also recorded.

Results

The optimal cutoff value for differentiating GLE and DLE was 4, which identified 80.6% of DLE cases. No statistically significant difference in GLE and DLE distribution was found between surgeons (P = 0.43). The correlation between difficult intubation and DLE was statistically significant (P = 0.03). The intraoperative parameters determining DLE were epiglottis characteristics (floppy, tight, or short), bulky abdomen and chest, bulky tongue base, mobile teeth, and a narrow laryngeal aditus.

Conclusion

The Laryngoscore is reliable for detecting DLE preoperatively. The inclusion of additional parameters may allow a more complete assessment and maximize its diagnostic accuracy.

Level of Evidence

Laryngoscope, 129:1438–1443, 2019

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Citing Literature

Volume129, Issue6

June 2019

Pages 1438-1443

Predicting laryngeal exposure in microlaryngoscopy: External validation of the laryngoscore

Abstract

Objectives

Study Design

Methods

Results

Conclusion

Level of Evidence

BIBLIOGRAPHY

Citing Literature

References

Information

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Predicting laryngeal exposure in microlaryngoscopy: External validation of the laryngoscore

Abstract

Objectives

Study Design

Methods

Results

Conclusion

Level of Evidence

BIBLIOGRAPHY

Citing Literature

References

Related

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