How reliable is the Laryngoscore in predicting difficult laryngeal exposure (DLE) in patients undergoing elective microlaryngoscopy?
Bottom Line: The Laryngoscore is reliable for detecting DLE preoperatively, but each institution should find its own best cutoff value based on the specific instruments available locally.
Explore This IssueJune 2019
Background: Microlaryngoscopy is used to obtain complete larynx visualization required to maximize functional outcome during phonosurgery and to completely resect the tumor and lessen local recurrence risk during laryngeal cancer removal. The Laryngoscore, with 11 parameters to predict DLE, while reported as easy to use, reliable, and reproducible, has never undergone external validation.
Study design: Prospective validation study of 136 consecutive patients who were preoperatively evaluated using the Laryngoscore.
Setting: ENT Clinic, Head and Neck Department and the Biostatistics Unit–Department of Medical, Surgical and Health Science, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy.
Synopsis: Patients were scheduled for surgery for benign lesions or precancerous and neoplastic lesions. The number of patients in the merged Laryngoscore classes A, B, and C were 105, 11, and 20, respectively. Classes B and C were pooled together as group DLE (31 patients), while class A was defined as group GLE (good largyngeal exposure; 105 patients). Laryngoscore accuracy was tested by receiver operating characteristic (ROC) analysis. The area under the curve was 0.73, or moderately accurate according to the Swets classification. The cutoff value for discrimination between GLE and DLE was 4 (using the Youden method). Univariate analysis revealed a statistically significant correlation of upper jaw dental status and DLE, but not for interincisor gap, thyromental distance, trismus, macroglossia, micrognathia, degree of neck flexion-extension, previous treatment, Mallampati score, or BMI. Intraoperative parameters making anterior commissure exposure difficult related to epiglottis characteristics, bulky abdomen and chest, bulky tongue base, mobile teeth, and narrow laryngeal aditus. Difficult intubation and DLE showed a statistically significant correlation.
Citation: Tirelli G, Gatto A, Fortunati A, et al. Predicting laryngeal exposure in microlaryngoscopy: external validation of the laryngoscore. Laryngoscope. 2019;129:1438–1443.