Difficulty Systematized Evaluation of Vocal Folds Exposure in Microsurgery of the Larynx

• Main Authors: Ballin, Annelyse Cristine, Macedo Filho, Evaldo Dacheux de, Sela, Gustavo B, Catani, Guilherme S, Ido Filho, Jorge Massaaki, Ballin, Carlos Henrique, Mocellin, Marcos
• Format: Article
• Language: English
• Published: Thieme Revinter Publicações Ltda. 2010-09-01
• Series: International Archives of Otorhinolaryngology
• Subjects: Larynx; Intubation; Laryngoscopes; Microsurgery; Vocal fold; Repertory: section larynx and trachea
• Online Access: http://www.arquivosdeorl.org.br/conteudo/acervo_eng.asp?id=702

Introduction: Several studies addressing preoperative factors that predict difficulty of endotracheal intubation graduated by anesthesiologists, for the scale of the Cormack-Lehane. These parameters were evaluated for the difficulty of location of the laryngoscope in microsurgery of the larynx. There is not a standard scale of difficulty targeted to surgeons of the larynx. Objective: Create a standard scale of difficulty leasing the laryngoscope during microsurgery of the larynx, with a focus on exposure of the vocal folds (vocal cords) to evaluate which clinical parameters predict difficulty of exposure of their vocal folds and verify the improvement of laryngeal exposure with the hanger of the laryngoscope. Method: A prospective randomized study, 57 patients undergoing laryngeal microsurgery. The preoperative parameters were evaluated: three epidemiological data, two of history and 13 physical examination. Intraoperatively: the anesthesiologist evaluated the Cormack-Lehane score and the surgeon evaluated according to the proposed scale, before and after placement of the hanger. Results and Conclusion: Several parameters showed sensitivity, specificity, positive predictive value for high inadequate exposure of the larynx. But only distance hiomentual <6.05 cm (p = 0.003) and 2 classes of Cormack-Lehane (p = 0.04) with statistical significance and high sensitivity of 100% and 81% respectively. The use of the hanger of laryngoscope laryngeal exposure improved significantly (p = 0.04). The proposed scale standardizes the visualization and grades the difficulty of exposure of their vocal folds, facilitating comparisons between studies and communication between otolaryngologists.