Prediction of difficult laryngeal exposure in microlaryngoscopy: a scoping review.

OBJECTIVE: To conduct a scoping review on difficult laryngeal exposure (DLE) prediction in microlaryngoscopy (MLS). The aim was to identify effective predictive scoring systems or parameters for predicting transoral exposure. METHODS: A comprehensive search was conducted in PubMed and Scopus, with the final search performed on December 19th, 2024. Studies assessing preoperative predictors of DLE in MLS were included if they reported accuracy measures. Studies not in English, with insufficient data, and with sample size < 5 patients were excluded. RESULTS: Sixteen studies were analysed. Common predictors included body mass index, neck circumference, inter-incisor gap, thyromental distance, dental status, and the modified Mallampati index. Scoring systems like the Laryngoscore and the mini-Laryngoscore showed promise but varied in external validation. CONCLUSIONS: DLE prediction for MLS remains underdeveloped. Validated predictive tools could improve patient selection, reduce operative times, and optimise oncological outcomes by ensuring effective exposure. Further research is needed to establish robust predictive models.