Piazza Cesare, Mangili Stefano, Bon Francesca Del, Paderno Alberto, Grazioli Paola, Barbieri Diego, Perotti Pietro, Garofolo Sabrina, Nicolai Piero, Peretti Giorgio
Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Brescia.
Laryngoscope. 2014 Nov;124(11):2561-7. doi: 10.1002/lary.24803. Epub 2014 Jun 26.
OBJECTIVES/HYPOTHESIS: To identify a clinical predictor score for difficult laryngeal exposure (DLE) during operative microlaryngoscopy.
Prospective cohort study in two academic institutions.
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.
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).
The Laryngoscore is a good predictor of DLE and assists in selecting the ideal candidates for operative microlaryngoscopy.
2b.
目的/假设：确定在显微喉镜手术中困难喉镜暴露（DLE）的临床预测评分。
在两家学术机构进行的前瞻性队列研究。
我们通过标准化的术前评估方案（喉镜评分）对319例接受显微喉镜检查的声门良性和恶性疾病患者进行评估，该方案包括11项参数：门齿间距（IIG）、甲状软骨-颏下距离、上颌牙齿状况、牙关紧闭、下颌前突、巨舌症、小颌畸形、颈部屈伸程度、既往颈部开放手术和/或放疗史、改良的Mallampati评分以及体重指数（BMI）。对每个参数进行评估以获得总分。根据前联合（AC）可视化情况将患者分为五类：0类，在博伊斯-杰克逊体位使用大口径喉镜可完全可视化AC；I类，与0类相同，但施加外部喉部对抗压力；II类，在屈曲-屈曲体位与I类相同；III类，与II类相同，但使用小口径喉镜；IV类，无法可视化AC。
0-I-II类（良好/可接受的喉镜暴露）的中位评分为<6分。该值被选作区分有利与困难/无法进行喉镜暴露的临界值。当喉镜评分为<6分时，94%的患者喉镜暴露良好，而当≥6分时，40%的患者出现DLE。当考虑喉镜评分为≥9分时，67%的患者出现DLE。单因素分析显示，IIG、上颌牙齿状况、巨舌症、小颌畸形、颈部屈伸程度和BMI对DLE有统计学影响（P<0.05）。
喉镜评分是DLE的良好预测指标，有助于选择显微喉镜手术的理想候选者。
2b。
