title: Difficult Laryngeal Exposure in Microlaryngoscopy: Can it be Predicted Preoperatively?
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.
authors.affiliation: Department of ENT, Christian Medical College, Vellore, 632004 Tamil Nadu India.
authors.forename: Roshna Rose
authors.initials: RR
authors.lastname: Paul
authors.affiliation: Department of ENT, Christian Medical College, Vellore, 632004 Tamil Nadu India.
authors.forename: Ajoy Mathew
authors.initials: AM
authors.lastname: Varghese
authors.affiliation: Department of ENT, Christian Medical College, Vellore, 632004 Tamil Nadu India.
authors.forename: John
authors.initials: J
authors.lastname: Mathew
authors.affiliation: Department of ENT, Christian Medical College, Vellore, 632004 Tamil Nadu India.
authors.forename: Ramanathan
authors.initials: R
authors.lastname: Chandrasekharan
authors.affiliation: Department of ENT, Indira Gandhi Medical College and Research Institute, Pondicherry, India.
authors.forename: Sophia
authors.initials: S
authors.lastname: Amalanathan
authors.affiliation: Department of ENT, Christian Medical College, Vellore, 632004 Tamil Nadu India.
authors.forename: Syed Kamran
authors.initials: SK
authors.lastname: Asif
authors.affiliation: Department of ENT, Christian Medical College, Vellore, 632004 Tamil Nadu India.
authors.forename: Mary
authors.initials: M
authors.lastname: Kurien
keywords: Atlanto-occipital extension; Difficult laryngeal exposure (DLE); Microlaryngoscopy; Neck circumference; Odds Ratio; Pre-op clinical parameters