title: Soft tissue injuries after direct laryngoscopy.
abstract: OBJECTIVE
  The study objective is to determine the incidence of oral soft tissue trauma during classic direct laryngoscopy for tracheal intubation and the risk factors associated with it.
  
  
  METHODS
  This is a prospective observational study.
  
  
  METHODS
  The setting is at a ward.
  
  
  METHODS
  The patients are adults submitted to elective interventions in general surgery requiring tracheal intubation by classic direct laryngoscopy.
  
  
  METHODS
  During 6 months, all patients were interviewed 12-24 hours before anesthesia and after surgery and underwent a detailed oral examination performed by an anesthesiology blind to anesthetic management details and preoperative patient care.
  
  
  METHODS
  Evaluation of oral soft tissue injuries includes oral mucosa including the gums; the alveolar mucosa in the edentulous patient, palate, and the buccal mucosa; lips (mucosa and skin); and the tongue. Injury severity was assessed using the severity scale presented routinely in Portuguese legal medicine research: grade 0, no injuries had; grade 1, mild severity injuries; grade 2, medium severity injuries; and grade 3, major severity injuries.
  
  
  RESULTS
  Soft tissue trauma was observed in 278 (52.1%) patients. Soft tissue injury occurred once in 204 (38.2%) patients, 2 in 64 (38.2%) patients, and 3 times in 10 (1.9%) patients. Tongue injury was the most common type of soft tissue trauma (36.3%) followed by lower lip injury (22.3%), upper lip injury (7.1%), and oral mucosa injury (2.1%). All the lesions were grade 1 or 2. Only oral mucosa injury was found to be associated with age group (P = .021).
  
  
  CONCLUSIONS
  Our study reveals a high incidence of lesions grade 1 or 2 in soft tissue.
authors.affiliation: Department of Anesthesiology Centro Hospitalar São João, EPE, Porto, Portugal; Anesthesiology and Perioperative Care Unit, Department of Surgery, Faculty of Medicine, University of Porto, Porto, Portugal. Electronic address: joanamourao1@sapo.pt.
authors.forename: J
authors.initials: J
authors.lastname: Mourão
authors.affiliation: Department of Anesthesiology Centro Hospitalar de São João, EPE, Porto, Portugal.
authors.forename: J
authors.initials: J
authors.lastname: Moreira
authors.affiliation: Center for Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal.
authors.forename: J
authors.initials: J
authors.lastname: Barbosa
authors.affiliation: Oral Surgery, Faculty of Dental Medicine, University of Porto, Porto, Portugal.
authors.forename: J
authors.initials: J
authors.lastname: Carvalho
authors.affiliation: Anesthesiology and Perioperative Care Unit, Department of Surgery, Faculty of Medicine, University of Porto, Porto, Portugal.
authors.forename: J
authors.initials: J
authors.lastname: Tavares
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D015994:Incidence; D007442:Intubation, Intratracheal / Q000009:adverse effects* / Q000379:methods; D007828:Laryngoscopy / Q000009:adverse effects* / Q000379:methods; D008046:Lip / Q000293:injuries; D008297:Male; D008875:Middle Aged; D009061:Mouth Mucosa / Q000293:injuries; D011446:Prospective Studies; D012307:Risk Factors; D017695:Soft Tissue Injuries / Q000453:epidemiology / Q000209:etiology*; D014059:Tongue / Q000293:injuries; D015599:Trauma Severity Indices; D055815:Young Adult
keywords: Airway management; Intubation; Laryngoscopy complications