Prospective Evaluation and Validation of the Laryngoscore and the mini‐Laryngoscore

Abstract

ObjectiveThe Laryngoscore was described in 2014 as a practical preoperative assessment tool to predict difficult laryngeal exposure (DLE) during transoral approaches to the larynx. In 2019 the authors proposed a version with a reduced number of variables, called the mini‐Laryngoscore. We aim to critically appraise and externally validate these two tools and if needed and possible, to optimize these tools.Methods103 consecutive patients who underwent a microlaryngoscopy between November 2017 and June 2020 at the Leuven University Hospitals were prospectively included and subjected to a presurgical evaluation of 15 parameters and a peroperative scoring of the anterior commissure visualization. Subsequent analysis focused on the concordance of our findings with those of Piazza et al., the discriminatory ability of the test, and the validity of the included items. We then evaluated a modified prediction tool.ResultsOf 103 patients, 18 (17.5%) had DLE. The Laryngoscore and mini‐Laryngoscore predicted this with a “good” C‐index of respectively 0.727 (95%CI: 0.608–0.846) and 0.714 (95%CI: 0.605–0.823). A newly created prediction tool including only three parameters (Interincisors gap, upper jaw dental status and previous treatments) showed a better discriminatory ability (C‐index = 0.835, 95%CI: 0.726–0.944) than the original Laryngoscore, a finding that needs further external validation.ConclusionThe original Laryngoscore and the mini‐Laryngoscore displayed a good discriminative ability. Some parameters can be left out of the Laryngoscore without losing discrimination. An even better prediction model seems possible, using a weighted sum of selected predictor variables and by using the parameters in their continuous form.Level of Evidence2 Laryngoscope, 2023

Predictors of Difficult Laryngeal Exposure in Suspension Laryngoscopy: A Systematic Review and Meta-Analysis

“…The absence of teeth increases the mouth space and enlarges the IIG. Some researchers have observed that the likelihood of DLE increases progressively by dental status, in the order of edentulous, partially edentulous, normal teeth, and prominent teeth [ 4 , 39 , 40 ]. Considering the various anatomical distances, even a minor difference in each one-dimensional parameter can combine to yield a significant discrepancy in the three-dimensional structure of the pharyngeal space.…”