The effect of periorbital cooling on pain, edema and ecchymosis after rhinoplasty: a randomized, controlled, observer-blinded study.

INTRODUCTION: Success and satisfactory results in rhinoplasty are established not only with flawless surgery but also with meticulous perioperative care. Pain stays at the centre of these circumstances. Besides, several contributing perioperative factors such as periorbital edema and ecchymosis play key role on the patients' comfort. METHODS: Septorhinoplasty was carried out in 50 patients between February and May 2014 under general anesthesia. Local anesthesia with lidocaine and adrenaline combination was done prior to incision. Following the procedure, silicone gel packs were applied. One periorbital region was cooled after surgery whereas the opposite site was left uncooled. Periorbital edema-ecchmosis and pain intensity were graded and noted 1 hour, 1 day, 3 days, 1 week and 1 month after surgery. RESULTS: Cold application seriously reduced postoperative edema and ecchymosis at the first week (p=0.001 for the first 3 days and p=0.006 at first week). Pain was reduced with cooling not on the first hour (p>0.05), but on the forthcoming days throughout the first week (p<0.005). Operation time revealed that primary cases were carried out quicker than revisional surgery. Moreover, pain scores were found lower in primary cases than revisions, especially in the first 3 days. These finding were approved statistically. CONCLUSION: Cooling of the periorbital region reduces edema and ecchymosis as well as pain; however 3 days of use is enough after rhinoplasty. One hour after surgery, cooling does not affect the pain but reduce edema and ecchymosis.

Congenital agenesis of the internal jugular vein: an extremely rare anomaly.

Vascular anomalies of major venous vessels are rarely seen. Moreover, congenital absence of internal jugular vein is extremely uncommon. In our case, a female patient presented with primary unknown left cervical mass. Cervical ultrasonography demonstrated absence of right internal jugular vein. In addition, computed tomography and dynamic magnetic resonance imaging scans confirmed this diagnosis. Compensatory left internal jugular vein enlargement mimicked sort of cervical mass. Venous magnetic resonance imaging images revealed the absence of right internal jugular vein with compensatory left internal jugular vein dominance. In the literature, the agenesis of IJV was mentioned in a case with concomitant multiple problems. Here, an asymptomatic case is reported with an incident diagnosis. No interventions were planned upon the patient's request. It should be kept in mind that any kind of anomalies can be seen during venous access and neck surgery.

Does body mass index matter while selecting the flap type for pharyngeal reconstructions?

The aim of our study was to investigate the effect of patient-related factors, such as the body mass index (BMI) and tumor size, in selecting the flap type for the reconstruction of pharyngeal defects. This retrospective review included 182 patients with pharyngeal defect reconstructions with free and pedicled flaps at the Ohio State University from January 2005 to December 2008. We conducted a retrospective comparison of variety of different flap reconstruction techniques. We compared different flap reconstruction with BMI and tumor size without functional outcome such as swallowing and speech data. Although there was no statistically significant correlation (P > 0.05) when comparing the free flaps with pedicled flaps according to the BMI and tumor size, there was an obvious tendency to prefer radial forearm free flap over anterolateral thigh free flap in patients who are overweight and those with obesity with a ratio of 32:3. In the same group of patients, a similar tendency was observed to prefer fibular free flap over iliac crest free flap with a ratio of 14:5, whereas the ratio was becoming 3:5 in favor of iliac crest free flap over fibular free flap in patients with BMI of 24 or lower. Despite the fact that surgeons' experience with a certain flap type is one of the most important factors while determining which flap to reconstruct, BMI might have a significant impact while selecting the free flap types for the reconstruction of pharyngeal defects.

Two new polymers as candidates for rhinoplasty allografts: an experimental study in a rabbit model.

OBJECTIVES: This study was performed to evaluate the biocompatibility and tensile strength of two new polymeric materials--a polyfluoro ether-modified thermoplastic polyurethane urea and a polydimethyl silicone elastomer--in an experimental rabbit model. METHODS: The two polymers were implanted inside separate subperichondrial pockets created over the auricular cartilages of 12 rabbits. A control pocket received no implant. After 3 months, the animals were painlessly sacrificed, and each site was analyzed histologically for vascular congestion, acute and chronic inflammation, and fibrosis in the tissue surrounding the implant materials. RESULTS: There were no statistically significant differences in vascular congestion, fibrosis, or acute or chronic inflammation between the control sites and either implant site. CONCLUSIONS: These results suggest that the polymers are well accepted by the tissue and remain stable during the entire study period, and that they could be very suitable materials for use in nasal reconstruction.

Histopathologic parameters in chronic rhinosinusitis with nasal polyposis: impact on quality of life outcomes.

BACKGROUND: Chronic rhinosinusitis (CRS) is a common disease with a significant impact on health-related quality of life (QOL) of the patient. Histologic inflammatory markers in CRS are an important marker in determining the severity of the disease. In this study, we evaluated the association of histopathologic parameters with QOL questionnaires in patients with CRS with nasal polyposis after endoscopic sinus surgery (ESS). METHODS: A total of 57 patients were included in this study. Preoperative patient characteristics, clinical findings, and computed tomography scores were recorded. Two QOL measures, the Rhinosinusitis Disability Index (RSDI) and Short Form-36 General Health Survey (SF-36) were analyzed preoperatively and postoperatively. Sinus mucosal specimens were collected at the time of surgery. Presence of the inflammation was evaluated with cellular (eosinophils, neutrophils, lymphocytes, mast cells, macrophages), epithelial (basement membrane thickness [BMT], goblet cell) and stromal markers (subepithelial edema). The histopathological findings were compared statistically with the QOL measures. RESULTS: In comparison of the absolute change of the RSDI and SF-36 scores with mucosal eosinophilia, patients with eosinophilia showed significantly less improvement only in the SF-36 physical functioning subscale (p = 0.004). There was a statistically significant relationship between BMT and RSDI total (p = 0.042), emotional scores (p = 0.003), SF-36 general health (p = 0.032), SF-36 physical function (p = 0.007), SF-36 bodily pain (p = 0.044), and SF-36 mental health (p = 0.022). CONCLUSION: For most patients QOL significantly improved after surgery. Mucosal eosinophilia did not correlate with the absolute change of the RSDI. However, thickening of basal membrane adversely affects symptoms of the patients and correlates with the disease severity.

Complications of tracheoesophageal puncture and speech valves: retrospective analysis of 47 patients.

OBJECTIVES: This study aims to evaluate the complications of tracheoesophageal puncture (TEP) for voice restoration and speech valves in patients undergoing total laryngectomy. PATIENTS AND METHODS: Between January 2006 and June 2011, 47 male patients (mean age 62.8±1.2 years; range 41 to 80 years) who underwent TEP and speech valve for voice restoration after total laryngectomy were retrospectively analyzed. Secondary TEP was performed and Provox indwelling voice prosthesis were inserted in all patients. Demographic, disease and treatment characteristics of patients were recorded. Complications related to TEP and speech valves, the management of complications and clinical conditions of complete closure of TEP were also recorded. RESULTS: Tracheoesophageal puncture and speech valve related complications were observed in 20 patients. The majority of complications were minor complications including granulation tissue formation (n=2, 4.2%), deglutition of prosthesis (n=6, 12.7%) and TEP enlargement/leakage around prosthesis (n=9, 19.1%). Major complications were observed in three patients. Two of them were life-threatening complications; a mediastinitis (n=1, 3.1%) and paraesophageal abscess (n=1, 3.1%), and both appeared in the first month of the postoperative period. The overall complication rate was 42.6% during mean follow-up of 15.3 months. Tracheoesophageal fistula enlargement (n=9, 19.1%) was the most common minor complication and the most common cause of complete closure of TEP in this study. CONCLUSION: Tracheoesophageal puncture for voice restoration is not an entirely innocent procedure without any complications. Patients should be monitored for TEP-related complications in the early and late postoperative period.

MRI assessment of internal acoustic canal variations using 3D-FIESTA sequences.

Magnetic resonance imaging (MRI) of the internal acoustic canal is the standard diagnostic tool for a wide range of indications in patients. This study aims to investigate the vascular variations and compression of the cranial nerves (CNs) VII and VIII at the cerebellopontine angle in patients with neuro-otologic symptoms using 3D-fast imaging employing steady-state acquisition (FIESTA) MR imaging. One hundred and eighty-seven patients (374 temporal bones) were examined on a 1.5-T MRI. In addition to conventional MR sequences, a 3D-FIESTA MR imaging was acquired. Magnetic resonance images thus obtained were evaluated with special regard to the presence of vascular contact to the CNs VII and VIII, as well as the presence of the vascular variations of the anterior inferior cerebellar artery (AICA) causing the compression of CNs. The Chi-squared test was used for statistical analysis. No statistically significant differences were found between the presence and absence of the AICA loop and/or vascular contact for the clinical symptoms of patients (P > 0.05). The cisternal and canalicular segments of CNs VII and VIII and adjacent vascular variations are well identified using 3D-FIESTA, especially by determining the relationship of the AICA variations between CNs.

Endonasal endoscopic approach for recurrent nasolabial cyst.

Nasolabial cysts are rare nonodontogenic cystic lesions in the soft tissue of the midface and usually present with painless asymptomatic swelling in the nasolabial region. Surgical excision via sublabial approach is considered as the standard treatment. However, endonasal endoscopic marsupialization of the cyst is reported as an effective alternative method for nasolabial cysts. Marsupialization of the cyst is believed to integrate the nasolabial cyst into a part of the nasal cavity as an air-containing sinus. In this article, we present an endonasal endoscopic marsupialization technique in case of recurrent nasolabial cyst. To draw attention to this approach, we present our case with current literature.

Supracricoid partial laryngectomy: analyses of oncologic and functional outcomes.

OBJECTIVE: The aim of this study was to analyze the functional and oncologic results of supracricoid partial laryngectomy. STUDY DESIGN: Case series with chart review. SETTING: Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey. SUBJECT AND METHODS: The medical records of 56 patients, who underwent supracricoid partial laryngectomy between March 2002 and December 2010, were reviewed in this study. Forty-three patients underwent supracricoid partial laryngectomy with cricohyoidopexy, and 13 patients underwent cricohyoidoepiglottopexy. The overall and disease-specific survival, local control rates, and the mean time of decannulation and nasogastric tube removal were evaluated. Association of type of surgery with the functional and oncologic outcomes was evaluated and statistically compared. RESULTS: The median follow-up period was 58 months. The 1-, 3-, and 5-year overall survival rates were 100%, 96.4%, and 82.1%, respectively. The 1-, 3-, and 5-year local control rates were 100%, 96.1%, and 92.5%, respectively. Type of surgery did not show any significant difference in survival and local control rates (P = .546, P = .455). The mean (SD) decannulation and nasogastric feeding tube removal time was 11.43 (2.03) and 16.79 (3.51) days, respectively. The mean time of decannulation and nasogastric tube removal was significantly longer in patients who underwent cricohyoidopexy when compared with those who underwent cricohyoidoepiglottopexy (P = .002, P = .000). CONCLUSION: Although delaying deglutition functions could be termed a disadvantage of supracricoid laryngectomy, especially with cricohyoidopexy, supracricoid laryngectomy has reliable oncologic and functional results for locally advanced laryngeal cancers while maintaining laryngeal functions.

[Approaches to antrochoanal polyps in adults: long-term comparative results]. / Eriskinlerde antrokoanal poliplere yaklasim: Uzun dönem karsilastirmali sonuçlar.

OBJECTIVES: This study aims to evaluate the long-term results of endoscopic sinus surgery and combined approach with Caldwell Luc procedure for the treatment of antrochoanal polyps. PATIENTS AND METHODS: Between January 2002 and December 2009, 41 patients (24 males, 17 females; mean age 34.7 years; range 14 to 78 years) were retrospectively analyzed. Patients were divided into two groups according to treatment modality: group 1 included 26 patients who underwent endoscopic sinus surgery alone and group 2 included 15 patients who underwent endoscopic sinus surgery in combination with Caldwell Luc procedure. Both groups were compared for recurrence and complication rate. RESULTS: Seventeen of 41 patients were diagnosed with right-sided lesions, while 24 patients had left-sided lesions. Recurrence was seen in three patients, including two were in the group 1 and one was in the group 2. There was no statistically significantly difference between the groups in terms of recurrence and complication rate (p>0.05). Mean follow-up was 50.5 months (range 15 to 94 months). CONCLUSION: Current approach for the treatment of antrochoanal polyps is endoscopic sinus surgery. However, combined approaches should be performed to avoid recurrences, unless removal of antral part of the antrochoanal polyp completely by endoscopic resection is possible. Selection of the combined techniques depends on the surgeon familiarity with the procedure and whether the patient is pediatric case. Combined approach with Caldwell Luc is a safe procedure in adults.

Recovery of hearing in Cisplatin-induced ototoxicity in the Guinea pig with intratympanic dexamethasone.

The purpose of this study was to investigate the effectiveness of intratympanic dexamethasone injection as a therapeutic agent against cisplatin-induced ototoxicity. Animals were randomly divided into three groups. Group one received intraperitoneal cisplatin alone, group two, received intratympanic dexamethasone after cisplatin ototoxicity had been demonstrated. Group three, which is control group, received intratympanic dexamethasone.Then we made three measurements. First we measured the baseline distortion product otoacustic emission (DPOAEs) of all the guine pigs. Second we injected cisplatin intraperitoneal group one and two the same day. Third we measured DPOAEs after 72 h of group one and two. Moreover DPOAEs were measured at the end of the first and second week only in group two. Cochleae were harvested and processed for electron microscopy after then. Values of The DPOAEs amplitudes and signal-to-noise ratio (SNR) at 1-6 kHz frequencies for group 1 after the injections significantly decreased over those before injections (P < 0.05). In group 3, there were no significant differences in DPOAE amplitude and SNR values When they are compare before and after their intratympanic dexamethasone injections (P > 0.05). In group 2, the DPOAEs measurements were close to significance at the end of the second week (P = 0.056). Intratympanic dexamethasone injection did not cause any ototoxic effect. Although intratympanic dexamethasone did not reach the statistically significant results, the measurements were close to significance. Intratympanic dexamethasone might have a significant therapeutic effect after cisplatin ototoxicity with different dose and application regimens.

Pharyngocutaneous fistula after total laryngectomy: Less common with mechanical stapler closure.

OBJECTIVES: The aim of the study was to compare the incidences of pharyngocutaneous fistula after total laryngectomy between patients who underwent manual and mechanical suturing for pharyngoesophageal closure. METHODS: In a retrospective and prospective nonrandomized clinical study conducted at a single tertiary medical center between May 2002 and April 2009, we compared the incidence of pharyngocutaneous salivary fistula between two groups of patients after total laryngectomy. Sixty-one consecutive patients who underwent mechanical suturing with a 60-mm linear stapler (group A) were prospectively enrolled, and 121 patients who had undergone manual suturing (group B) were retrospectively reviewed. RESULTS: The groups were similar in terms of age, gender, comorbidities, TNM (tumor, node, metastasis) stage, and laryngeal tumor extension. The incidence of pharyngocutaneous salivary fistula was 4.9% in group A and 19.8% in group B (p = 0.014). CONCLUSIONS: Mechanical stapler closure of the pharynx after total laryngectomy was associated with a significant reduction in the incidence of pharyngocutaneous fistula compared with manual suture in selected cases.

[The evaluation of cordectomy cases without tracheotomy in laryngeal cancer]. / Larenks kanserlerinde trakeotomisiz kordektomi olgularinin degerlendirilmesi.

OBJECTIVES: We evaluated the technique of laryngofissure cordectomy without tracheotomy in patients with T1a laryngeal carcinoma. PATIENTS AND METHODS: Twelve male patients (mean age 55 years; range 47 to 68 years) who were diagnosed with T1a laryngeal carcinoma and treated with cordectomy without tracheotomy between January 2005 and March 2008 in our clinic were evaluated with retrospective review of medical charts. They were all treated with laryngofissure and cordectomy. The cord with carcinoma was excised with the inner perichondrium of thyroid cartilage and surgical margins were examined hystopatologically with frozen section. Postoperative oncologic and functional results were evaluated. RESULTS: None of the patients were treated with preoperative or postoperative tracheotomy. Oral nutrition was initiated on the 3rd postoperative day and the patients were discharged. No tumor recurrences were seen in the postoperative follow-ups. CONCLUSION: Although the surgical area is slightly restricted due to the use of entubation tube, cordectomy without tracheotomy had better functional results and the oncological results were unchanged compared to cordectomy with tracheotomy. Since the procedure is without tracheotomy, psychological adaptation period of the patients was shorter compared to the patients treated cordectomies with tracheotomy.

Evaluation of p53, p63, p21, p27, ki-67 in paranasal sinus squamous cell carcinoma and inverted papilloma.

Using a molecular genetic approach, we try to confirm the molecular alterations of inverted papilloma and clarify its status as a putative precursor lesion of sinonasal squamous cell carcinoma. To better understand its genetics, we investigated the immunohistochemical protein expression patterns of cell-cycle-regulators p53, p63, p21, p27 and proliferation marker Ki-67 in 22 inverted papilloma and 9 squamous cell carcinoma of the sinonasal tract. Significantly elevated levels of p53 and p63 in squamous cell carcinoma of sinonasal tract compared with inverted papilloma were revealed. Ki-67-stained neoplastic cell nuclei were found in a significantly higher percentage of squamous cell carcinoma of sinonasal tract than in inverted papilloma, whereas no variation of p21 and p27 expression was identified. This work first examined the immunohistochemical overexpression of p63 in sinonasal inverted papilloma and squamous cell carcinoma. In conclusion, this is a first study shedding light on the expression of p63 in tumors of paranasal sinuses.

Measurements of the facial recess anatomy: implications for sparing the facial nerve and chorda tympani during posterior tympanotomy.

Posterior tympanotomy is commonly performed through the facial recess to facilitate cochlear implantation. A rare but serious complication of this procedure is paralysis of the facial nerve and/or the chorda tympani. These complications generally occur because of a limited understanding of the anatomy of the facial recess. To help further define this area, we used computer-aided design software to measure (1) the angle between the facial nerve and the chorda tympani nerve and (2) the distance between the takeoff point of the chorda tympani and the posteriormost prominent point of the short process of the incus in 30 cadaveric adult temporal bones. The mean angle was 23.58° (±6.84), and the mean distance was 7.78 mm (±2.68). Our most important finding was that there was a correlation between the two measurements in that the distance tended to be greater when the angle was less than the mean and vice versa. This trend approached but did not quite reach statistical significance (r = -0.248, p = 0.059).

Evaluation of bacterial biofilms in chronic rhinosinusitis.

OBJECTIVE: We investigated the presence of biofilms in patients with chronic rhinosinusitis. DESIGN: Prospective study. METHODS: Thirty patients with chronic rhinosinusitis scheduled for endoscopic sinus surgery were enrolled in this study. Nasal swab cultures were taken at the time of surgery. Samples were cultured using conventional methods for Haemophilus influenzae, Pseudomonas aeruginosa, Streptococcus pneumoniae, and Staphylococcus aureus. MAIN OUTCOME MEASURES: Culture-positive samples were evaluated for slime-forming ability. Qualitative detection of biofilm formation by all slime-producing strains was studied by culturing the strains on Congo red agar plates. RESULTS: Twenty-three of 30 patients' samples were culture positive (76.6%). Thirteen S. aureus and 10 P. aeruginosa cultures were identified on 23 specimens. Bacterial biofilms were present on 15 of 23 (65.2%) culture-positive specimens. Nine of 13 (69.2%) S. aureus cultures and 6 of 10 (60%) P. aeruginosa cultures produced bacterial biofilms. CONCLUSION: This conventional method is capable of demonstrating biofilm-forming ability in bacteria recovered from patients with chronic rhinosinusitis. The biofilm-forming ability was higher in S. aureus compared with P. aeruginosa.

[Differential diagnosis in cervical lymphadenopathies: efficacy of B-mode, color and power Doppler ultrasonography]. / Servikal lenfadenopatilerin ayirici tanisinda B-mod, renkli ve power Doppler ultrasonografinin etkinligi.

OBJECTIVES: Our purpose was to investigate cervical lymphadenopathies by using color Doppler spectral analysis and power Doppler ultrasonography methods as well as B-mode ultrasound and to classify them as malignant or benign lesions and to compare the results with the histopathological findings. PATIENTS AND METHODS: Sixty-nine lymph nodes of 69 patients were evaluated with color and power Doppler ultrasonography as well as B-mode ultrasonography. The shape and dimensions of the lymph nodes were assessed with B-mode ultrasonography; their vascularization pattern with power Doppler sonography and with color Doppler spectral analysis. Vascular pattern was evaluated according to the vascularization of the lymph node. Vascular resistive index and pulsatility index were assessed by at least three flow samplings. We measured resistive index, pulsatility index, peak systolic velocity, and end diastolic velocity. Results of Doppler analysis were compared with clinical findings and histopathologic results. Nodes were grouped as metastasis, lymphoma, tuberculosis, and reactive benign lymphadenopathies with respect to ultrasonographic results. RESULTS: Forty-four of 69 lymph nodes were found to be malignant histopathologically. In color Doppler analysis, most malign metastatic lymphadenopathies showed peripheral (76.4%), and the rest of them (23.6%) showed peripheral and hilar (mix) vascularization. Most benign lymphadenopathies (88%) and lymphomatous lymphadenopathies (85%) had hilar vascularization. In tuberculous lymphadenopathies, 50% of them showed avascular pattern and the rest of them had variable type of vascularization. A resistive index = or > 0.7 indicated a malignant metastatic lymphadenopathy and a resistive index <0.5 was consistent with benign lesions. In lymphomatous and tuberculous lymphadenopathies resistive index values were between 0.6-0.7. The sensitivity of the resistive index for distinguishing inflammatory from neoplastic lymphadenopathies was 84.6%, the specificity 100% and the diagnostic accuracy 95.7% (p<0.001). CONCLUSION: In addition to B-mode ultrasonography findings, vascularity pattern assessment and spectral analytical measurements with color and power Doppler ultrasonography has an important contribution for the differential diagnosis of cervical lympadenopathies.

[Stomal recurrence after total laryngectomy: clinical and patological analysis of risk factors]. / Total larenjektomi sonrasi stomal nüks: Risk faktörlerinin klinik ve patolojik analizi.

OBJECTIVES: The aim of this study is to evaluate risk factors for stomal recurrence and to state and emphasize the importance of these factors. PATIENTS AND METHODS: This study was carried out retrospectively on 119 patients (116 males, 3 females; mean age 56.8 years; range 31 to 86 years) with larynx cancer who underwent total laryngectomy. All patients were examined for T-stage and location of primary tumor, tracheotomy (preoperative or postoperative) opening time, modality of applied treatment, presence of pharyngeal stoma fistula and presence of cervical lymph node metastasis in the postoperative period. RESULTS: Five patients (4.2%) out of 119 had stomal recurrence. Development period of stomal recurrence after laryngectomy was found to be between six months and three years (mean: 16.6 months). CONCLUSION: The treatment of this fatal complication is very difficult, and it has a poor prognostic nature. As a result, presence of subglottic involvement and advanced tumors in our cases are considered as main risk factors.

[Evaluation of superior semicircular canal dehiscence in patients with vertigo and tinnitus]. / Vertigo ve tinnituslu hastalarda süperior semisirküler kanal dehissansinin arastirilmasi.

OBJECTIVES: The aim of the study was to investigate the presence of superior semicircular canal dehiscence (SSC) in patients with unknown etilogy of vertigo/tinnitus. PATIENTS AND METHODS: This study was performed prospectively between December 2007 and March 2008. Fifty five patients (23 males, 32 females; mean age 44.5; range 36 to 74 year) with complaints of vertigo and/or tinnitus, of which we couldn,t establish the etiologies, were included in the study. Control group was consisted of 15 patients who didn,t have complaints of vertigo and/or tinnitus. A high resolution temporal bone computed tomograpy (CT) scan (1 mm slice thickness) was performed in all study groups (patients and controls). RESULTS: Thirty nine subjects (72%) had normal odiometric findings. Mild conductive hearing loss was present in 12 (22%) subjects. Two (3%) of the patients had moderate conductive hearing loss and the other two subjects (3%) had mixed type hearing loss. High resolution temporal bone CT scan revealed that 35 (65%) subjects had dehissence around SSC otic capsule whereas 20 (35%) remaining patients yielded no dehissence. Twenty one of 35 patients (60%) with dehissence at SSC had minimum defect and 14 patients (40%) had significant defect. Bilateral defect was present in nine (64%) of 14 patients with significant defect but none of the subjects with minimum defect showed bilateral involvement. None of the control subjects exhibited SSC dehissence with CT imaging. CONCLUSION: Semicircular canal dehissence was found in 65% of the patients with unknown etiology of the vertigo and tinnitus. Physicians should evaluate the SSC dehissence in patients with vertigo and tinnitus as an etiologic factor.

Preoperative clinical prediction of difficult laryngeal exposure in suspension laryngoscopy.

We investigated general and physical predictors of difficult laryngeal exposure in patients undergoing suspension laryngoscopy; 93 patients were included in this prospective study. The patients were classified as difficult laryngeal exposure group or non-difficult laryngeal exposure group based on the laryngeal view in suspension laryngoscopy. Twelve parameters (age, sex, body mass index, neck circumference, full mouth opening, modified mallampati index, hyoid-mental, thyroid-mental, horizontal thyroid-mental, vertical thyroid-mental, sternum-mental distance) that could predict difficult laryngeal exposure were evaluated. Of 93 patients, 22 had difficult laryngeal exposure. Cormack-Lehane score, neck circumference, body mass index, modified mallampati index, hyoid-mental, thyroid-mental, vertical thyroid-mental, and sternum-mental distance showed significant correlation with difficult laryngeal exposure. Based on the multivariate analysis, neck circumference superior to 40 cm, hyoid-mental and sternum-mental distance with respectively a value less than 6.05 and 13.9 cm were independently associated with difficult laryngeal exposure. Muscular neck, hyoid-mental and sterno-mental distance should be considered clinical predictors of difficult laryngeal exposure. Measurements of physical variables at full extension position of the neck are more useful and reliable predictors than neutral position for the risk of difficult laryngeal exposure.