Nautiyal Saurabh, Kumar Agarwal Vinish, Bist S S, Kumar Lovneesh, Luthra Mahima
Department of ENT, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Jollygrant, 248016 Dehradun, Uttarakhand India.
Indian J Otolaryngol Head Neck Surg. 2024 Feb;76(1):490-494. doi: 10.1007/s12070-023-04190-6. Epub 2023 Sep 1.
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.
Prospective, Cross-sectional, Observational study.
Department of Otorhinolaryngology in a tertiary care teaching facility.
150 patients were included with an endolaryngeal disease who were planned for surgery with age > 18yrs.
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.
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.
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.
喉部的正确可视化对于诊断评估和治疗干预至关重要。外科医生面临的最大挑战是看清声门区的前联合。本研究的目的是记录接受喉内手术患者的术前喉镜评分，并通过与术前喉镜评分相关联来评估术中喉部暴露困难的术前预测因素。
前瞻性、横断面、观察性研究。
一家三级医疗教学机构的耳鼻喉科。
纳入150例年龄大于18岁、患有喉内疾病且计划接受手术的患者。
计算150例受试者的术前喉镜评分，该评分包含11项参数，包括甲状软骨-颏下距离、下颌前突、巨舌、小下颌、牙关紧闭、切牙间隙、颈部屈伸程度、既往颈部开放性手术或放疗史、上颌牙齿状况、改良马兰帕蒂评分和体重指数，以得出总分，最高分为17分。根据手术中前联合的可视化情况，将所有患者分为五类，从0类到IV类。对喉镜评分参数进行评估，并与术中前联合可视化的五类情况进行统计学比较。
150例患者中，70例（46.6%）的喉镜评分为3 - 4分，其次是45例（30%）患者的喉镜评分为5 - 6分。共有123例（82%）患者术中前联合可视化情况为0、1和2类，而27例（18%）患者为3和4类。如果喉镜评分小于或等于5分，90%的患者喉部暴露良好，而只有10%的患者喉部暴露困难。在单因素分析中，发现甲状软骨-颏下距离、颈部屈伸程度和改良马兰帕蒂分级对于前联合可视化困难具有统计学意义。
一个合理、简便且有效的术前喉镜评分可能对识别术中喉部暴露困难有显著帮助。这可能防止手术不充分、手术放弃、术中并发症以及喉科医生面临的医疗法律案件。
