Suspension Laryngoscopy Experiences in a Tertiary Airway Service: a
Prospective Study of 150 Procedures
Abstract Objectives: In most cases, suspension laryngoscopy (SL) is
efficient, bloodless and with minimal post-procedure discomfort. We
aimed to identify predictive patient factors for acceptable surgical
views at SL as well as quantify our tertiary airway unit’s complication
rates. Design: Prospective cohort study of 150 consecutive
microlaryngoscopy procedures involving SL over an 8-month period between
November 2019 and July 2020. Patients were assessed pre-operatively for
pre-existing oral, temporomandibular, dental, pharyngeal or laryngeal
pathology, interincisor distance and qualitative gross limitations to
neck extension and forward head posture. Intraoperatively, the
laryngoscopic view was graded by anesthetic and surgical teams, and
complications were recorded on patient interview in recovery. Setting:
Tertiary adult airway service for predominantly benign pathology.
Results: Adequate surgical views were obtained in 149/150 procedures.
BMI and limitations to chin and neck movement had mild positive
correlations with more difficult views in their own rights, but did not
correlate with a statistically significant increase in complications.
There was a negative correlation between age and interincisor gap
(p=0.014), and wider mouth opening correlated with a lower incidence of
sore throat (p=0.023). Macroglossia showed a statistically significant
positive correlation with tongue symptoms (p=1.611x10-8). Conclusion: In
the context of an experienced airway unit with a high caseload of
predominantly benign pathology, SL is very effective and safe with low
associated morbidity and no mortality. Patient-reported neck and chin
movement were found to correlate well with the surgical view obtained.
The most common complication of SL is temporary sore throat and there
remain recognized risks of temporary tongue and dental symptoms.