A prospective study on predictive model for difficult laryngeal exposure based on Chinese population

Objective To construct a simplified predictive model for difficult laryngeal exposure (DLE) during laryngomicrosurgery in Chinese population and evaluate its clinical value.

Methods A total of 384 patients with laryngomicrosurgery from January 2022 to December 2023 were selected. DLE was defined as Cormack-Lehane grades Ⅲ to Ⅳ. Univariate analysis and multivariate Logistic regression were used to screen independent risk factors. A predictive model was constructed incorporating 5 parameters: body mass index (BMI) ≥28 kg/m², neck circumference ≥40 cm, thyromental distance < 6.5 cm, modified Mallampati classification grades Ⅲ to Ⅳ, and moderate-to-severe restriction of neck mobility. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve and the Bootstrap method were employed to validate the performance of the model.

Results The model demonstrated a negative predictive value of 95.3%, good discriminatory performance (AUC=0.876, 95%CI, 0.835 to 0.917), and stable internal validation (adjusted AUC=0.862). When the cut-off value was ≥3 points, the model exhibited a sensitivity of 86.0% and a specificity of 82.6%.

Conclusion This model can accurately identify patients at high risk of DLE before surgery, providing a reference for individualized surgical preparation.