SpringerLink
Log in

Assessment of Preoperative Predictors for Difficult Laryngeal Exposure in Endolaryngeal Surgery

  • Original Article
  • Published:
Indian Journal of Otolaryngology and Head & Neck Surgery Aims and scope Submit manuscript

Abstract

Introduction

The proper visualisation of the larynx is required for the diagnostic assessment and therapeutic intervention. The most significant challenges for surgeon is to visualise the anterior commissure of the glottis region. The aim of this study is to record the preoperative laryngoscore in patients posted for endolaryngeal surgery and to assess preoperative predictors for intraoperative difficult laryngeal exposure by correlating with preoperative laryngoscore.

Design

Prospective, Cross-sectional, Observational study.

Setting

Department of Otorhinolaryngology in a tertiary care teaching facility.

Subjects

150 patients were included with an endolaryngeal disease who were planned for surgery with age > 18yrs.

Methodology

In 150 subjects preoperative laryngoscore was calculated, which comprised 11 parameters including thyromental distance, mandibular prognathism, macroglossia, micrognathia, trismus, inter incisor gap, degree of neck flexion-extension, history of prior open-neck surgery or radiotherapy, upper jaw dental status, modified Mallampati score and body mass index in order to produce a total score out of a possible maximum score of 17. According to the anterior commissure visualisation all patients were categorised into five classes, ranging from class 0 to class IV during surgery. The laryngoscore parameters were assessed and compared statistically with five classes of intraoperative anterior commissure visualisation.

Result

Out of 150 patients 70 (46.6%) were having 3–4 laryngoscore, followed by 45 (30%) patients with 5–6 laryngoscore. Total 123 (82%) patient had class 0,1 and 2 intraoperative anterior commissure visualisation while 27 (18%) had class 3 and 4 visualisation. If laryngoscore was either less or equal to 5, 90% of the patients had excellent laryngeal exposure whereas only 10% of the patients had challenging laryngeal exposure. At univariate analysis, thyromental distance, degree of neck flexion/extension, and modified Mallampati classification were found statistically significant for difficulty of anterior commissure visualisation independently.

Conclusion

A sound, easy and valid preoperative laryngoscore may be significantly helpful in identifying intraoperative difficult laryngeal exposure. This may prevent inadequacy of surgery, abandon of surgery, intra operative complication, and medico-legal cases for laryngologist.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Lungova V, Thibeault SL (2020) Mechanisms of larynx and vocal fold development and pathogenesis. Cellular and Molecular Life Sciences. Out;77:3781-95

  2. Kawakita D, Matsuo K (2017) Alcohol and head and neck cancer. Cancer Metastasis Rev 36:425–434

    Article  CAS  PubMed  Google Scholar 

  3. 5, Silver CE, Moisa II (1990 May-Jun) The role of surgery in the treatment of laryngeal cancer. CA Cancer J Clin 40(3):134–149

  4. Steiner W, Ambrosch P, Rödel 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

    Article  PubMed  Google Scholar 

  5. Sivaraj P (2017) Predictability of Difficult Laryngoscopy and Intubation using the Clinical and Radiological Imaging Study (Doctoral dissertation, Chengalpattu Medical College, Chengalpattu), vol. 4, no. 82, pp. 4825– 4829,

  6. Ohno S, Hirano S, Tateya I, Kojima T, Ito J (2011) Management of vocal fold lesions in difficult laryngeal exposure patients in phonomicrosurgery. Auris Nasus Larynx 38(3):373–380

    Article  PubMed  Google Scholar 

  7. Arjun AP, Dutta A (2019) A study of application of preoperative clinical predictors of difficult laryngeal exposure for Microlaryngoscopy: the Laryngoscore in the indian Population. Indian J Otolaryngol Head Neck Surg 71(4):480–485

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Kharrat I, Achour I, Trabelsi JJ, Trigui M, Thabet W, Mnejja M et al (2022) Prediction of difficulty in direct laryngoscopy. Sci Rep 06(24):10722

    Article  Google Scholar 

  9. Singhal P, Bhandari A, Chouhan M, Sharma P, Sharma S (2009) Benign tumours of larynx-A clinical study of 50 cases. Indian J Otorhinolaryngol Head Neck Surg 61:26–30

    Article  Google Scholar 

  10. New GB, Erich JB (1938) Benign tumors of the larynx: a study of seven hundred and twenty-two cases. Arch Otolaryngol 28(6):841–910

    Article  Google Scholar 

  11. Nallathambi C, Yumkhaibam SD, Singh LJ, Singh TT, Singh IY, Daniel N (2016) Clinico-epidemiologic patterns of Laryngeal Cancer: 5-year results from a Regional Cancer Centre in northeastern India. Asian Pac J Cancer Prev 17(5):2439–2443

    PubMed  Google Scholar 

  12. Kumar A, Sharma A, Ahlawat B, Sharma S (2014) Site specific effect of tobacco addiction in upper aerodigestive tract tumors: a retrospective clinicopathological study. ScientificWorldJournal 2014:460194

    Article  PubMed  PubMed Central  Google Scholar 

  13. Baitha S, Raizada RM, Singh AK, Puttewar MP, Chaturvedi VN (2002) Clinical profile of hoarseness of voice. Indian J Otolaryngol Head Neck Surg 54(1):14–18

    Article  PubMed  PubMed Central  Google Scholar 

  14. Kim WH, Ahn HJ, Lee CJ, Shin BS, Ko JS, Choi SJ, Ryu SA (2011) Neck circumference to thyromental distance ratio: a new predictor of difficult intubation in obese patients. Br J Anaesth 106(5):743–748

    Article  CAS  PubMed  Google Scholar 

  15. Piazza C, Mangili S, Bon FD, Paderno A, Grazioli P, Barbieri D, Perotti P, Garofolo S, Nicolai P, Peretti G (2014) Preoperative clinical predictors of difficult laryngeal exposure for microlaryngoscopy: the laryngoscore. Laryngoscope 124(11):25617

    Article  Google Scholar 

  16. Mallampati SR, Gatt SP, Gugino LD, Desai SP, Waraksa B, Freiberger D, Liu PL (1985) A clinical sign to predict difficult tracheal intubation; a prospective study. Can Anaesthetists’ Soc J 32(4):429–434

    Article  CAS  Google Scholar 

  17. Roh JL, Lee YW (2005) Prediction of difficult laryngeal exposure in patients undergoing microlaryngosurgery. Ann Otol Rhinol Laryngol 114(8):614–620

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of ENT, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Jollygrant, 248016, Dehradun, Uttarakhand, India

    Saurabh Nautiyal, Vinish Kumar Agarwal, S.S. Bist, Lovneesh Kumar & Mahima Luthra

Authors
  1. Saurabh Nautiyal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vinish Kumar Agarwal
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S.S. Bist
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lovneesh Kumar
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mahima Luthra
    View author publications

    You can also search for this author in PubMed Google Scholar

Ethics declarations

Conflict of interest

Nil.

Financial support – Nil.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nautiyal, S., Kumar Agarwal, V., Bist, S. et al. Assessment of Preoperative Predictors for Difficult Laryngeal Exposure in Endolaryngeal Surgery. Indian J Otolaryngol Head Neck Surg 76, 490–494 (2024). https://doi.org/10.1007/s12070-023-04190-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12070-023-04190-6

Keywords

Search

Navigation