Radiological Predictors of Difficult Laryngeal Exposure in Laryngomicrosurgery

Lee, Dong Won; Park, Keon; Ji, Yong Bae; Cho, Seok Hyun; Park, Chul Won; Tae, Kyung

Abstract

BACKGROUND AND OBJECTIVES
Laryngeal microsurgery (LMS) is a common procedure for diagnosis and treatment of various laryngeal diseases. Sometimes, laryngeal exposure is poor and LMS may be impossible. The aim of this study was to investigate factors related to difficult laryngeal exposure in LMS.
SUBJECTS AND METHOD
Three hundred patients who underwent LMS were enrolled in this study. The patients were categorized into 3 subgroups (easy exposure group, moderate exposure group, and difficult exposure group) according to the glottic visualization under suspension laryngoscopy. The 14 parameters on lateral extension neck X-ray in the closed and open mouth view were analyzed to evaluate laryngeal exposure.
RESULTS
The study included 168 males and 132 female patients with the mean age of 48.36+/-12.39 (10-79) years. Of 300 patients, 244 patients were classified as the easy exposure group, 41 as the moderate exposure group, and 15 as the difficult exposure group. Patients with difficult laryngeal exposure were significantly higher in males (p<0.001). Among 14 radiologic parameters, thyroid incisor angle in closed mouth view (p=0.003) and sternum-mentum distance in open mouth view (p=0.04) were significantly related with difficult laryngeal exposure on the multivariate analysis.
CONCLUSION
Being a male, having a narrow thyroid incisor angle in the closed mouth view and having a short sternum-mentum distance in the open mouth view are useful patient indications that serve to predict difficult laryngeal exposure in LMS.