{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T07:18:20Z","timestamp":1777706300842,"version":"3.51.4"},"reference-count":29,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T00:00:00Z","timestamp":1772150400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T00:00:00Z","timestamp":1772150400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Several factors are reported as predictors of difficult laryngeal exposure (DLE). This study investigates force metrics associated with predictive factors of DLE during suspension microlaryngoscopy (SML) utilizing data recorded by the laryngeal force sensor (LFS). We hypothesize that patient factors associated with DLE will record higher forces during laryngeal surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>Prospective observational cohort clinical trial data examining secondary endpoints.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Tertiary medical center.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The LFS recorded maximum force and average force during SML in 214 laryngeal surgeries. Patient characteristics, and perioperative factors such as interincisor distance (ID), Mallampati scores, cervical spine stiffness, thyromental (TM) distance, and laryngeal grade view during intubation, were also recorded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Patients included ranged from 19 to 90 years, with a median age of 57 years. A higher Mallampati score corresponded to a higher average force and maximum force (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.002,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.003). Patients with an ID of \u22644.5\u2009cm experienced nearly double the average force when compared to edentulous patients (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.002). Height (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.001) and a shorter TM distance were associated with higher force metrics. There was also a difference in force metrics between the sexes, with men experiencing a higher average force (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009\u2264\u2009.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Elevated force metrics during SML are correlated with predictive indicators for difficult intubation and laryngeal exposure. These metrics could help identify patients at higher risk of requiring increased force during both intubation and SML, leading to potential postoperative complications.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ohn.70180","type":"journal-article","created":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T09:36:37Z","timestamp":1772962597000},"page":"1306-1312","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Higher Force Metrics Associated With Known Risk Factors for Difficult Laryngeal Exposure"],"prefix":"10.1002","volume":"174","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2571-8428","authenticated-orcid":false,"given":"Lily","family":"Stevenson","sequence":"first","affiliation":[{"name":"Department of Otolaryngology Mass Eye and Ear Boston Massachusetts 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