Difficult laryngeal exposure in microlaryngoscopy: Can it be predicted preoperatively?

Roshna Rose Paul*, Ajoy Mathew Varghese, John Mathew, Ramanathan Chandrasekharan, Sophia Amalanathan, Syed Kamran Asif, Mary Kurien

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

8 Citations (Scopus)


The aim of the present study was to identify preoperative clinical predictors for difficult laryngeal exposure (DLE) and to define a simple grading system for laryngeal exposure. This is a prospective descriptive study carried out in a tertiary teaching hospital in South India. Patients above 18 years undergoing microlaryngoscopy had presurgical evaluation of 11 physical parameters. Grading of Modified Cormack-Lehane Score (MCLS) and rigid laryngoscopy were done during procedure. On logistic regression analysis, with a 95 % confidence interval (CI) MCLS was found to be a statistically significant predictor (odds ratio 12). With 90 % CI, neck circumference, atlanto-occipital extension and MCLS were significant (odds ratio of 4, 4, 12 respectively). Neck circumference of more than 34.25 cm and limited atlantooccipital extension of less than 19.50, predicts difficult laryngeal exposure. A simple grading system for laryngeal exposure during microlaryngoscopy is being proposed. MCLS grade more than 2a done intra operatively correlates well with difficult intubation.

Original languageEnglish
Pages (from-to)65-70
Number of pages6
JournalIndian Journal of Otolaryngology and Head and Neck Surgery
Issue number1
Publication statusPublished - Sept 21 2016
Externally publishedYes


  • Atlanto-occipital extension
  • Difficult laryngeal exposure (DLE)
  • Microlaryngoscopy
  • Neck circumference
  • Odds Ratio
  • Pre-op clinical parameters

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology


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