Abstract
The aim of the present study was to identify preoperative clinical predictors for difficult laryngeal exposure (DLE) and to define a simple grading system for laryngeal exposure. This is a prospective descriptive study carried out in a tertiary teaching hospital in South India. Patients above 18 years undergoing microlaryngoscopy had presurgical evaluation of 11 physical parameters. Grading of Modified Cormack–Lehane Score (MCLS) and rigid laryngoscopy were done during procedure. On logistic regression analysis, with a 95 % confidence interval (CI) MCLS was found to be a statistically significant predictor (odds ratio 12). With 90 % CI, neck circumference, atlanto-occipital extension and MCLS were significant (odds ratio of 4, 4, 12 respectively). Neck circumference of more than 34.25 cm and limited atlanto-occipital extension of less than 19.50, predicts difficult laryngeal exposure. A simple grading system for laryngeal exposure during microlaryngoscopy is being proposed. MCLS grade more than 2a done intra operatively correlates well with difficult intubation.
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Zeitels SM, Vaughan CW (1994) “External counterpressure” and “internal distention” for optimal laryngoscopic exposure of the anterior glottal commissure. Ann Otol Rhinol Laryngol 103:669–675
Hsiung MW, Pai L, Kang BH, Wang BL, Wong CS, Wang HW (2004) Clinical predictors of difficult laryngeal exposure. Laryngoscope 114(2):358–363
Roh JL, Lee YW (2005) Prediction of difficult laryngeal exposure in patients undergoing microlaryngosurgery. Ann Otol Rhinol Laryngol 114(8):614–620
Pinar E, Calli C, Oncel S, Selek B, Tatar B (2009) Preoperative clinical prediction of difficult laryngeal exposure in suspension laryngoscopy. Eur Arch Otorhinolaryngol 266(5):699–703
Hekiert AM, Mick R, Mirza N (2007) Prediction of difficult laryngoscopy: does obesity play a role? Ann Otol Rhinol Laryngol 116(11):799–804
Koh LK, Kong CE, Ip-Yam PC (2002) The modified Cormack-Lehane score for the grading of direct laryngoscopy: evaluation in the Asian population. Anaesth Intensive Care 30(1):48–51
Bagatella F, Bignardi L (1981) Morphological study of the laryngeal anterior commissure with regard to the spread of cancer. Acta Otolaryngol 92(1–2):167–171
Steiner W, Ambrosch P, Rodel RM, Kron M (2004) Impact of anterior commissure involvement on local control of early glottic carcinoma treated by laser microresection. Laryngoscope 114(8):1485–1491
Tillmann B, Paulsen F, Werner JA (1994) Structures of the anterior commissure of the larynx. Biomechanical and clinical aspects. Laryngorhinootologie 73(8):423–427
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Sophia Amalanathan was formerly Assistant Professor in Department of ENT, Christian Medical College, Vellore.
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Paul, R.R., Varghese, A.M., Mathew, J. et al. Difficult Laryngeal Exposure in Microlaryngoscopy: Can it be Predicted Preoperatively?. Indian J Otolaryngol Head Neck Surg 68, 65–70 (2016). https://doi.org/10.1007/s12070-015-0913-9
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DOI: https://doi.org/10.1007/s12070-015-0913-9