Arquivos Internacionais de Otorrinolaringologia 2010; 14(03): 294-301
DOI: 10.1590/S1809-48722010000300005
Original Article
Thieme Publicações Ltda Rio de Janeiro, Brazil

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

Avaliação Sistematizada da Dificuldade de Exposição das Pregas Vocais na Microcirurgia da Laringe
Annelyse Cristine Ballin
*   Resident in the third year of the Department of Otorhinolaryngology, HC-UFPR.
,
Evaldo Dacheux de Macedo Filho
**   Doctor. Medical Chief of the Laryngology of Otorhinolaryngology, HC-UFPR and IPO.
,
Gustavo B. Sela
***   Academic Travel Medicine, UFPR.
,
Guilherme S. Catani
****   Collaborating Professor, Department of Laryngology of the HC-UFPR.
,
Jorge Massaaki Ido Filho
****   Collaborating Professor, Department of Laryngology of the HC-UFPR.
,
Carlos Henrique Ballin
*****   Doctoral Course of Medicine, UFPR.
,
Marcos Mocellin
******   Head and Professor of Otolaryngology Department of the HC-UFPR.
› Author Affiliations
Further Information

Publication History

11 February 2010

31 May 2010

Publication Date:
12 February 2014 (online)

Summary

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.

Resumo

Introdução: Diversos estudos abordam fatores pré-operatórios que predizem dificuldade de intubação endotraqueal, graduada pelos anestesistas pela escala de Cormack-Lehane. Estes parâmetros foram pouco avaliados para a dificuldade de locação do laringoscópio nas microcirurgias da laringe. Não há uma escala padrão de dificuldade direcionada aos cirurgiões de laringe.

Objetivo: Criar uma escala padrão de dificuldade de locação do laringoscópio durante microcirurgia da laringe, com foco na exposição das pregas vocais (PPVV); avaliar quais parâmetros clínicos predizem dificuldade de exposição das PPVV; verificar a melhora da exposição laríngea com o suspensor do laringoscópio.

Método: Estudo prospectivo, randomizado, de 57 pacientes submetidos à microcirurgia de laringe. No pré-operatório foram avaliados: 3 dados epidemiológicos, 2 de anamnese e 13 de exame físico. No intra-operatório: o anestesista avaliava o escore de Cormack-Lehane e o cirurgião avaliava conforme a escala proposta, antes e após a colocação do suspensor.

Resultados e Conclusão: Vários parâmetros apresentaram sensibilidade, especificidade, valor preditivo positivo altos para exposição inadequada da laringe. Porém, apenas distância hiomentual <6,05cm (p = 0,003) e classe 2 de Cormack-Lehane (p = 0,04) com significância estatística e alta sensibilidade, 100% e 81% respectivamente. O uso do suspensor do laringoscópio melhorou a exposição laríngea de forma significativa (p = 0,04). A escala proposta padroniza a vizualização e gradua a dificuldade de exposição das PPVV, facilitando comparações entre estudos e comunicação entre otorrinolaringologistas.

 
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