title: Preoperative clinical predictors of difficult laryngeal exposure for microlaryngoscopy: the Laryngoscore.
abstract: OBJECTIVE
  To identify a clinical predictor score for difficult laryngeal exposure (DLE) during operative microlaryngoscopy.
  
  
  METHODS
  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.
  
  
  METHODS
  2b.
authors: Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Brescia.
authors: Cesare
authors: C
authors: Piazza
authors: Stefano
authors: S
authors: Mangili
authors: Francesca Del
authors: FD
authors: Bon
authors: Alberto
authors: A
authors: Paderno
authors: Paola
authors: P
authors: Grazioli
authors: Diego
authors: D
authors: Barbieri
authors: Pietro
authors: P
authors: Perotti
authors: Sabrina
authors: S
authors: Garofolo
authors: Piero
authors: P
authors: Nicolai
authors: Giorgio
authors: G
authors: Peretti
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D015331:Cohort Studies; D004867:Equipment Design; D005260:Female; D005931:Glottis / Q000601:surgery*; D006801:Humans; D007558:Italy; D007818:Laryngeal Diseases / Q000175:diagnosis / Q000601:surgery*; D020704:Laryngoscopes; D007828:Laryngoscopy / Q000379:methods*; D007830:Larynx / Q000002:abnormalities / Q000601:surgery; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000295:instrumentation* / Q000379:methods; D056888:Patient Positioning; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D015203:Reproducibility of Results
keywords: Difficult laryngeal exposure; benign glottic lesions; glottic tumor; microlaryngoscopy; transoral microsurgery