Preoperative predictors of difficult oropharyngeal exposure for transoral robotic surgery: The Pharyngoscore

• Published in: Head & neck Vol. 43; no. 10; pp. 3010 - 3021
• Main Authors: Gaino, Francesca, Gorphe, Philippe, Vander Poorten, Vincent, Holsinger, F. Christopher, Lira, Renan B., Duvvuri, Umamaheswar, Garrel, Renaud, Van Der Vorst, Sebastien, Cristalli, Giovanni, Ferreli, Fabio, De Virgilio, Armando, Giannitto, Caterina, Morenghi, Emanuela, Colombo, Giovanni, Malvezzi, Luca, Spriano, Giuseppe, Mercante, Giuseppe
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.10.2021; Wiley Subscription Services, Inc; Wiley
• Subjects: Anthropometry; Head & neck cancer; Human health and pathology; Humans; Life Sciences; Male; Microsurgery; Multivariate analysis; Natural Orifice Endoscopic Surgery; Nomograms; oropharyngeal cancer; oropharyngeal exposure; Oropharyngeal Neoplasms; Oropharynx; OSAS; Robotic surgery; Robotic Surgical Procedures; Sensory Organs; Statistical analysis; Surgery; Throat cancer; TORS; transoral robotic surgery; Treatment Outcome; OSAS; TORS; oropharyngeal cancer; transoral robotic surgery; oropharyngeal exposure
• ISSN: 1043-3074; 1097-0347; 1097-0347
• DOI: 10.1002/hed.26792

Background Insufficient exposure may require termination of procedure in transoral robotic surgery (TORS). The aim of study was to develop a “Pharyngoscore” to quantify the risk of difficult oropharyngeal exposure (DOE) before TORS. Methods Three‐hundred six patients undergoing any surgical procedure at one Academic Hospital were prospectively enrolled. Oropharynx was exposed with Feyh–Kastenbauer retractor. Exposure was evaluated by direct and endoscopic visualization of the four oropharyngeal subsites. Preoperative clinical/anthropometric parameters were studied in good oropharyngeal exposure and DOE groups. Logistic regression was performed to explore association between clinical/anthropometric parameters and DOE. Statistically significant parameters at multivariate analysis were incorporated into a nomogram. Results Sixty‐five (21.2%) subjects were characterized by DOE. Variables associated with DOE at univariate analysis were male (p = 0.031), modified Mallampati Class (MMC) ≥ III (p < 0.001), smaller interincisor gap (p < 0.001), and larger neck circumference (p = 0.006). MMC, interincisor gap, and neck circumference were significant at multivariate analysis and were presented with a nomogram for creating the Pharyngoscore. Conclusions The Pharyngoscore is a promising tool for calculating DOE probability before TORS.