Laryngeal Force Sensor for Suspension Microlaryngoscopy: A Prospective Controlled Trial

Abstract

Objectives The laryngeal force sensor (LFS) provides real-time force data for suspension microlaryngoscopy. This study investigates whether active use of the LFS can prevent the development of complications. Study Design Prospective controlled trial. Setting Academic tertiary center. Methods The LFS and custom software were developed to track intraoperative force metrics. A consecutive series of 100 patients had force data collected with operating surgeons blinded to intraoperative readings. The subsequent 100 patients had surgeons actively use the LFS monitoring system. Patients were prospectively enrolled, completing pre- and postoperative surveys to assess the development of tongue pain, paresthesia, paresis, dysgeusia, or dysphagia. Results On univariate analysis, the active monitoring group had lower total impulse ( P < .001) and fewer extralaryngeal complications ( P < .01). On multiple logistic regression, maximum force (odds ratio [OR], 1.08; 95% CI, 1.01-1.16; P = .02) was a significant predictive variable for the development of postoperative complications. Similarly, active LFS monitoring showed a 29.1% (95% CI, 15.7%-42.4%; P < .001) decrease in the likelihood of developing postoperative complications. These effects persisted at the first postoperative visit for maximum force ( P = .04) and active LFS monitoring ( P = .01). Maximum force (OR, 1.11; 95% CI, 1.04-1.18; P < .01) and active LFS monitoring (16.6%; 95% CI, 2.7%-30.5%; P = .02) were also predictive for the development of an abnormal 10-item Eating Assessment Tool score. These effects also persisted at the first postoperative visit for maximum force ( P = .01) and active LFS monitoring ( P = .01). Conclusion Maximum force is predictive of the development postoperative complications. Active monitoring with the LFS is able to mitigate these forces and prevent postoperative complications. Level of Evidence 2.

Dental impression silicone putty in transoral laser laryngeal surgery: prevention of oral complications

“…Even if the incidence of oral complications is relatively low and not life-threatening, the percentage of refunding requests in consequence to dental lesions is generally high. A recent study by Feng and colleagues showed the advantages of employing a laryngeal force sensor for suspension microlaryngoscopy in mitigating maximum forces and preventing post-operative complications 5 .…”

“…Even if the incidence of oral complications is relatively low and not life-threatening, the percentage of refunding requests in consequence to dental lesions is generally high. A recent study by Feng and colleagues showed the advantages of employing a laryngeal force sensor for suspension microlaryngoscopy in mitigating maximum forces and preventing post-operative complications 5 . Although our new technique has been successfully employed in our hospital for the past two years without reporting any case of gum or dental injury, the main purpose of this paper is merely to illustrate the procedure in detail; specific case-control studies will be necessary to compare the efficacy of the method compared to employment of traditional mouth guards.…”

Informed consent for suspension microlaryngoscopy: what should we tell the patient? A consensus statement of the European Laryngological Society

“…The relationship between forces used during SML and tongue-related symptoms has been prospectively analyzed. The maximum force has been stated to be predictive of the development of postoperative complications [ 12 ]. Female patients were considered to be at greater risk for developing postoperative tongue symptoms [ 13 ].…”

Design, development, and face validation of an intubation simulation device using real‐time force data feedback

“… 1 , 2 , 3 Previous studies from our group have shown that excessive forces exerted through laryngoscopes during suspension microlaryngoscopy are associated with soft tissue injuries within the oral cavity and other postprocedure complications like pain and neuropathy. 4 , 5 , 6 During intubation, excessive forces have been hypothesized to be a causative factor in postprocedure complications. Little research has been performed to quantify the force needed to cause such symptoms.…”

“…In inexperienced hands, this can lead to complications and life‐threatening situations, especially when managing the airway of a critically ill patient 1–3 . Previous studies from our group have shown that excessive forces exerted through laryngoscopes during suspension microlaryngoscopy are associated with soft tissue injuries within the oral cavity and other postprocedure complications like pain and neuropathy 4–6 . During intubation, excessive forces have been hypothesized to be a causative factor in postprocedure complications.…”