{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T01:03:48Z","timestamp":1788829428307,"version":"build-2803163510"},"reference-count":14,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2014,6,26]],"date-time":"2014-06-26T00:00:00Z","timestamp":1403740800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2014,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives\/Hypothesis<\/jats:title>\n                    <jats:p>To identify a clinical predictor score for difficult laryngeal exposure (DLE) during operative microlaryngoscopy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>Prospective cohort study in two academic institutions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We evaluated 319 patients before microlaryngoscopy for benign and malignant glottic diseases by a standardized preoperative assessment protocol (Laryngoscore) that included 11 parameters: interincisors gap (IIG), thyro\u2010mental distance, upper jaw dental status, trismus, mandibular prognathism, macroglossia, micrognathia, degree of neck flexion\u2010extension, history of previous open\u2010neck and\/or radiotherapy, Mallampati's modified score, and body mass index (BMI). Each parameter was assessed to obtain a total score. Patients were divided into five classes according to the anterior commissure (AC) visualization: class 0, complete AC visualization with large\u2010bore laryngoscopes in the Boyce\u2010Jackson position; class I, as class 0 with external laryngeal counterpressure; class II, as class I in the flexion\u2010flexion position; class III, as class II using small\u2010bore laryngoscopes; and class IV, impossible AC visualization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Class 0\u2010I\u2010II (good\/acceptable laryngeal exposure) presented a median score\u2009&lt;\u20096. This value was chosen as cutoff for distinguishing favorable versus difficult\/impossible laryngeal exposures. When the Laryngoscore was\u2009&lt;\u20096, good laryngeal exposure was observed in 94% of patients, whereas when\u2009\u2265\u20096, DLE was encountered in 40%. When considering a Laryngoscore of\u2009\u2265\u20099, 67% of patients had a DLE. At univariate analysis, IIG, upper jaw dental status, macroglossia, micrognathia, degree of neck flexion\u2010extension, and BMI statistically impacted on DLE (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The Laryngoscore is a good predictor of DLE and assists in selecting the ideal candidates for operative microlaryngoscopy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>\n                      2b.\n                      <jats:italic>Laryngoscope<\/jats:italic>\n                      , 124:2561\u20132567, 2014\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/lary.24803","type":"journal-article","created":{"date-parts":[[2014,6,26]],"date-time":"2014-06-26T05:32:20Z","timestamp":1403760740000},"page":"2561-2567","source":"Crossref","is-referenced-by-count":103,"title":["Preoperative clinical predictors of difficult laryngeal exposure for microlaryngoscopy: The laryngoscore"],"prefix":"10.1002","volume":"124","author":[{"given":"Cesare","family":"Piazza","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery University of Brescia Brescia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Mangili","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery University of Brescia Brescia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca Del","family":"Bon","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery University of Brescia Brescia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Paderno","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery University of Brescia Brescia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paola","family":"Grazioli","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery University of Brescia Brescia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diego","family":"Barbieri","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery University of Brescia Brescia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pietro","family":"Perotti","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery University of Brescia Brescia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabrina","family":"Garofolo","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery University of Genoa Genoa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piero","family":"Nicolai","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery University of Brescia Brescia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgio","family":"Peretti","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery University of Genoa Genoa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2014,6,26]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000539-199606000-00017"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/61.2.211"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF03011357"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1177\/000348940411300104"},{"key":"e_1_2_6_6_1","first-page":"17","article-title":"Cancer of the Larynx","author":"Jackson C","year":"1939","journal-title":"Philadelphia, PA: WB 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