Department of Otorhinolaryngology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, No. 1111 Xianxia Road, Shanghai 200336, China.
Department of Otorhinolaryngology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, No. 1111 Xianxia Road, Shanghai 200336, China.
Eur Ann Otorhinolaryngol Head Neck Dis. 2022 Aug;139(4):202-207. doi: 10.1016/j.anorl.2021.03.015. Epub 2022 Feb 8.
In our study, we hypothesized that sternum-mental angle (SMA) was a totally new preoperative predictor of difficult laryngeal exposure (DLE). The main objective of this study was to evaluate the diagnostic utility of SMA in predicting DLE in patients undergoing suspension microlaryngeal surgery, and we also searched for risk factors among the selected parameters.
A total of 95 patients with vocal cord dysfunction who underwent microlaryngeal surgery were collected. According to the Cormack-Lehane classification method, the patients were divided into non-DLE group (n=73) and DLE group (n=22). Preoperative assessments included age, sex, body mass index (BMI), Modified Mallampati's index (MMI), neck circumference (NC), thyroid-mental distance at neutral position (TMD-NP), TMD at full extension position (TMD-FE), sternum-mental distance at neutral position (SMD-NP), SMD at full extension position (SMD-FE), SMA at neutral position (SMA-NP) and SMA at full extension position (SMA-FE). SMA was defined as the angle between the horizontal line and the line from upper border of the manubrium sterni to mental prominence, and SMA's ability to predict difficult laryngoscopy was compared with that of established predictors.
The DLE incidence of the enrolled patients was 23%. Univariate analysis showed that patients in DLE group presented significantly smaller SMA values. SMA-NP less than 13 provided 68.2% sensitivity and 83.6% specificity and SMA-FE less than 22.5 provided 86.4% sensitivity and 80.8% specificity for the detection of DLE. SMA-FE (≤22.5) exhibited the largest area under the curve (AUC: 0.868; 95% CI: 0.784-0.952), confirming its better predictive ability. Binary multivariate logistic regression analyses identified four risk factors including MMI, TMD-FE, TMD-NP which were independently associated with DLE.
SMA is a new and simple predictor with a higher level of efficacy, and could help otorhinolaryngologist plan for managements in patients with DLE.
在我们的研究中，我们假设胸骨颏角（SMA）是预测困难喉镜显露（DLE）的全新术前预测指标。本研究的主要目的是评估 SMA 在预测行悬雍垂微瓣手术患者的 DLE 中的诊断效用，并在选定参数中寻找危险因素。
收集了 95 例声带功能障碍患者，均行微喉镜手术。根据 Cormack-Lehane 分类法，患者分为非 DLE 组（n=73）和 DLE 组（n=22）。术前评估包括年龄、性别、体重指数（BMI）、改良 Mallampati 指数（MMI）、颈围（NC）、中立位甲状腺颏距离（TMD-NP）、完全伸展位 TMD（TMD-FE）、中立位胸骨颏距离（SMD-NP）、完全伸展位 SMD（SMD-FE）、中立位 SMA（SMA-NP）和完全伸展位 SMA（SMA-FE）。SMA 定义为胸骨柄上缘与颏突之间的水平线与直线之间的夹角，比较 SMA 预测困难喉镜检查的能力与已建立的预测指标。
入组患者的 DLE 发生率为 23%。单因素分析显示，DLE 组患者的 SMA 值明显较小。SMA-NP 小于 13 时，检测 DLE 的灵敏度为 68.2%，特异性为 83.6%；SMA-FE 小于 22.5 时，灵敏度为 86.4%，特异性为 80.8%。SMA-FE（≤22.5）的曲线下面积（AUC）最大（0.868；95%CI：0.784-0.952），证实其具有更好的预测能力。二元多变量逻辑回归分析确定了 MMI、TMD-FE、TMD-NP 4 个独立与 DLE 相关的危险因素。
SMA 是一种新型、简单的预测指标，具有更高的疗效，有助于耳鼻喉科医生为 DLE 患者制定治疗计划。
