Treffer: Assessing Laryngeal Exposure: A Simple Scoring Tool for Predicting Difficult Laryngeal Exposure in Micro Laryngeal Surgery.

Background: Adequate visualisation of glottic plane is essential for optimal results in microlaryngeal surgery(MLS). Difficult laryngeal exposure (DLE) may result in suboptimal treatment, misdiagnosis, injury to teeth and pharyngeal soft tissue and even abortion of the procedure. Aim of this study was to assess the predictive accuracy of a six parameter scoring tool in identifying patients at risk for DLE during MLS. Materials and methods: A prospective observational study was conducted on 60 adult patients undergoing elective MLS for benign, premalignant and malignant lesions of the larynx. Six patients based parameters were evaluated: upper jaw dental status, degree of neck flexion-extension, modified Mallampati score, body mass index, thyromental distance and inter incisor gap. Score range of 0 to 12 was preoperatively assigned to patients with cut off of ≥ 6 indicating predicted DLE. Intraoperative glottic visualisation was graded and correlated with preoperative score using appropriate statistical methods. Results: DLE was encountered in 30% of all cases. The scoring system demonstrated 77.78% sensitivity, 80.95% specificity, 63.64% positive predictive value and 89.47% negative predictive value. Statistically significant correlation was found between total score and DLE(p = 0.013). Significant individual predictors of DLE included upper jaw dental status (p = 0.042), degree of neck flexion extension(p = 0.011), thyromental distance(p = 0.034) and inter incisor gap(p = 0.038). Modified Mallampati score(p = 0.617) and body mass index(p = 0.452) did not correlate with DLE. Conclusion: This scoring system is a reliable, practical and effective tool for predicting difficult laryngeal exposure in MLS. Its integration into preoperative assessment can significantly improve surgical preparedness reduce complication and enhance overall patient care. [ABSTRACT FROM AUTHOR]