A Study of Application of Preoperative Clinical Predictors of Difficult Laryngeal Exposure for Microlaryngoscopy: The Laryngoscore in the Indian Population

  • A. P. Arjun
  • Angshuman DuttaEmail author
Original Article


Good exposure for visualisation of the glottis is an essential prerequisite for effective microlaryngoscopy. There is no definitive clinical predictor scoring system to predict difficult microlaryngoscopy. The aim of the study was to study the validity of the Laryngoscore scoring system as a preoperative clinical predictor score in Indian population for difficult laryngeal exposure during microlaryngoscopy. A prospective study was carried out in 32 patients undergoing microlaryngoscopy in a tertiary care hospital who were evaluated by a standardized preoperative assessment protocol (Laryngoscore) which included 11 parameters interincisors gap, 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. Each parameter was assessed to obtain a total score (Maximum–17). Patients were divided into five classes according to the anterior commissure visualization: class 0 to class IV. Class 0 being complete and class IV being impossible AC visualization. When the Laryngoscore was < 6, good laryngeal exposure was observed in 94% of patients. Laryngoscore had a sensitivity of 87.5% and specificity of 75% in predicting difficult laryngeal exposure. The positive and negative predictive values of the same are 53.8% and 94.7% respectively. Our study found that the Laryngoscore scoring system as a preoperative indicator for predictor of Difficult Laryngeal Exposure during Micro Laryngeal surgeries is very useful in the Indian population.


Laryngoscore Laryngeal exposure Difficult laryngeal exposure Microlaryngoscopy Laryngology Preoperative Predictor Scoring system 


Compliance with Ethical Standards

Conflict of interest

There was no conflict of interest between the authors and there was no funding agency/source involved in this study.

Ethical Approval

All procedures performed in this study involving human participants were in accordance with the ethical standards and after approval of institutional ethical committee. The surgical team was the same in all cases to avoid observer bias in the scoring system.

Informed Consent

Informed consent was obtained from all patients included in the study.

Limitation of the Study

The sample size of the study was 32 in a single institution in comparison to the reference study [2] which had a sample size of 319 but was multicentric.


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Copyright information

© Association of Otolaryngologists of India 2019

Authors and Affiliations

  1. 1.Department of ENT & HNSCommand Hospital Air ForceBangaloreIndia

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