Soft tissue injuries after direct laryngoscopy

Study objective: The study objective is to determine the incidence of oral soft tissue trauma during classic direct laryngoscopy for tracheal intubation and the risk factors associated with it.

Design: This is a prospective observational study.

Setting: The setting is at a ward.

Patients: The patients are adults submitted to elective interventions in general surgery requiring tracheal intubation by classic direct laryngoscopy.

Interventions: During 6 months, all patients were interviewed 12-24 hours before anesthesia and after surgery and underwent a detailed oral examination performed by an anesthesiology blind to anesthetic management details and preoperative patient care.

Measurements: Evaluation of oral soft tissue injuries includes oral mucosa including the gums; the alveolar mucosa in the edentulous patient, palate, and the buccal mucosa; lips (mucosa and skin); and the tongue. Injury severity was assessed using the severity scale presented routinely in Portuguese legal medicine research: grade 0, no injuries had; grade 1, mild severity injuries; grade 2, medium severity injuries; and grade 3, major severity injuries.

Main results: Soft tissue trauma was observed in 278 (52.1%) patients. Soft tissue injury occurred once in 204 (38.2%) patients, 2 in 64 (38.2%) patients, and 3 times in 10 (1.9%) patients. Tongue injury was the most common type of soft tissue trauma (36.3%) followed by lower lip injury (22.3%), upper lip injury (7.1%), and oral mucosa injury (2.1%). All the lesions were grade 1 or 2. Only oral mucosa injury was found to be associated with age group (P = .021).

Conclusions: Our study reveals a high incidence of lesions grade 1 or 2 in soft tissue.