Introduction
Suspension laryngoscopy (SL) is a staple procedure in otolaryngology
which facilitates bimanual laryngeal instrumentation under direct
vision, thus permitting microlaryngeal surgery using a wide variety of
surgical techniques including cold steel excision, laser and
radiofrequency ablation. With a careful and standardized approach, SL is
usually efficient and bloodless with minimal post-procedure discomfort
following reversal of general anesthesia (1). As with every procedure,
there are recognized complications, the rates of which vary widely in
the global literature. A distinction can be made between minor or
temporary complications, which are generally localized to the oropharynx
(such as pain, mucosal abrasions or bruising, dental pain or temporary
tongue symptoms), and much rarer serious or permanent complications
(such as airway swelling, major cardiovascular instability, dental loss
or permanent tongue symptoms).
Multiple preoperative scoring systems have been proposed to predict the
acceptability of the view obtained at SL (2-7); however it is our view
that these often involve measuring excessive numbers of additional
variables outside of our routine clinical care, increasing time burdens
on staff without demonstrable gains in management-changing data. We
aimed to elucidate SL complication rates from our tertiary airway
population with comparison to the global literature, in order to:
- identify easy-to-measure factors which might predict acceptable
anesthetic and surgical views at SL;
- establish baselines against which to introduce measures to decrease
complications;
- identify potential at-risk subgroups who could benefit from additional
pre-operative planning to avoid injury; and
- increase the robustness of our consenting process.