Acta Scientific Otolaryngology (ASOL) (ISSN: 2582-5550)

Research Article Volume 4 Issue 6

Comparing the Use of the Flexible Laryngeal Mask Airway Versus the Endotracheal Tube in Upper Airway Surgery

Diala Al Mardini1, Peter Catalano1*, Rohan Wijewickrama1 and Ayman Fraihat2

1Department of Otolaryngology, St Elizabeth’s Medical Center, Brighton, MA, USA
2Department of Otolaryngology, Sulaiman Al Habib Medical Center, Dubai, UAE

*Corresponding Author: Peter Catalano, Department of Otolaryngology, St Elizabeth’s Medical Center, Brighton, MA, USA.

Received: May 06, 2022; Published: May 23, 2022


Objectives: The use of a flexible laryngeal mask (FLMA) during tonsillectomy and nasal/sinus surgery has been a controversial issue due to concerns regarding its efficacy in securing the airway and preventing potential airway complications like aspiration. This study aims at assessing the efficacy and safety of FLMA in upper airway surgery compared to the use of the standard endotracheal tube (ETT).

Method: Retrospective chart review of 229 patients who had undergone tonsillectomy alone or combined with nasal/sinus surgery, and whose airway was maintained with either a FLMA or ETT at our institution between 2016-2019. Adult and pediatric patients were included. Patient demographics, conversion rate from FLMA to ETT, LMA size modification rate, and LMA vs ETT related complications, induction time and extubation time were recorded for both groups and compared.

Results: 229 patients (128 pediatrics and 101 adults) had tonsillectomy alone or tonsillectomy combined with nasal/sinus surgery. 179 patients received FLMA, while 50 had an ETT during their surgery.

Conversion from LMA to ETT was carried out in only two adult cases (0.009%); one due to inadequate oral-pharyngeal space to perform tonsillectomy, and 1 due to an air leak after tonsillectomy requiring a larger size FLMA. None of the patients in the FLMA group developed aspiration pneumonia, bronchitis, or any other pulmonary complication. Two patients in the FLMA group developed cough 1 month postoperatively due to documented laryngeal reflux. All patients were discharged home on the same day of surgery except 1 adult patient with an ETT who was admitted overnight for monitoring due to postoperative desaturation and tachycardia.

The mean induction time and extubation time were both shorter when FLMA was used. The difference in the induction time was statistically significant (11.5 min ± 09 for ETT vs 7.8 min ± 0.3 for FLMA, P = 0.0003), as was the difference in extubation time (9.8 min ± 1.1 for ETT vs 7.1 min ± 0.4 for FLMA, P < 0.05).

Limitations: Retrospective chart review.

Conclusion: The use of a Flexible laryngeal mask airway is very safe and effective during upper airway surgery with minimal risk of pulmonary or cardiac complications and has the additional benefit of shorter induction and extubation time.

Keywords: Airway Surgery; Flexible Laryngeal Mask Airway; Endotracheal Tube


  1. Peng A., et al. “Use of Laryngeal Mask Airway in Pediatric Adenotonsillectomy”. Archives of Otolaryngology–Head and Neck Surgery 1 (2011): 42-46.
  2. Safaeian R., et al. “Postoperative Respiratory Complications of Laryngeal Mask Airway and Tracheal Tube in Ear, Nose and Throat Operations”. Anesthesia Pain Medicine4 (2015): e25111.
  3. Al-Mazrou KA., et al. “Laryngeal mask airway vs. uncuffed endotracheal tube for nasal and paranasal sinus surgery: paediatric airway protection”. European Journal of Anaesthesiology1 (2010): 16-19.
  4. Wood ML and ET Forrest. “The haemodynamic response to the insertion of the laryngeal mask airway: a comparison with laryngoscopy and tracheal intubation”. Acta Anaesthesiologica Scandinavica 5 (1994): 510-513.
  5. Gómez LM., et al. “Security and effectiveness of the laryngeal mask airway in the tonsillectomy and adenoidectomy: A systematic review of literature”. Colombian Journal of Anestesiology4 (2009): 321-339.
  6. Mandel JE. “Laryngeal mask airways in ear, nose, and throat procedures”. Anesthesiology Clinic3 (2010): 469-483.
  7. Boroda N., et al. “The use of laryngeal mask airway for adenoidectomy”. International Journal of Pediatric Otorhinolaryngology 107 (2013): 42-44.
  8. Thorning G., et al. “The laryngeal mask airway in elective paediatric day case ENT surgery: a prospective audit”. European Journal of Anaesthesiology11 (2016): 872-873.
  9. von Ungern-Sternberg BS., et al. “Laryngeal mask airway is associated with an increased incidence of adverse respiratory events in children with recent upper respiratory tract infections”. Anesthesiology 5 (2007): 714-719.
  10. Dolling S., et al. “A comparison of deep vs. awake removal of the laryngeal mask airway in paediatric dental day case surgery. A randomised controlled trial”. Anaesthesia 12 (2003): 1224-1228.
  11. Turnbull J and A Patel. “The use of the laryngeal mask airway in ENT surgery: Facts and fiction”. Trends in Anaesthesia and Critical Care6 (2013).
  12. Sierpina DI., et al. “Laryngeal mask airway versus endotracheal tube in pediatric adenotonsillectomy”. Laryngoscope 2 (2012): 429-435.
  13. Adams AS., et al. “Randomized controlled trial comparing the supraglottic airway to use of an endotracheal tube in sinonasal surgery”. International Forum of Allergy and Rhinology8 (2018): 877-882.
  14. van Esch BF., et al. “Comparison of laryngeal mask airway vs tracheal intubation: a systematic review on airway complications”. Journal of Clinical Anaesthesia 36 (2017): 142-150.
  15. Yu SH and OR Beirne. “Laryngeal mask airways have a lower risk of airway complications compared with endotracheal intubation: a systematic review”. Journal of Oral and Maxillofacial Surgery 10 (2010): 2359-2376.
  16. John RE., et al. “Airway protection by the laryngeal mask. A barrier to dye placed in the pharynx”. Anaesthesia5 (1991): 366-367.
  17. Haselby, K.A. “Laryngeal Mask Anesthesia: Principles and Practice. 2nd ed”. Anesthesia and Analgesia 102.5 (2006): 1599.
  18. Kaplan A., et al. “Airway protection and the laryngeal mask airway in sinus and nasal surgery”. Laryngoscope4 (2004): 652-655.
  19. Luce V., et al. “Supraglottic airway devices vs tracheal intubation in children: a quantitative meta-analysis of respiratory complications”. Paediatric Anaesthesia10 (2014): 1088-1098.
  20. Ovassapian A MD. “Laryngeal Mask Anesthesia: Principles and Practice, 2nd Edition”. Anesthesiology: The Journal of the American Society of Anesthesiologists 105.3 (2006): 636-636.
  21. Doksrød S., et al. “Reinforced laryngeal mask airway compared with endotracheal tube for adenotonsillectomies”. European Journal of Anaesthesiology11 (2010): 941-946.
  22. Webster AC., et al. “Anaesthesia for adenotonsillectomy: a comparison between tracheal intubation and the armoured laryngeal mask airway”. Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie12 (1993): 1171-1177.
  23. Baird MB., et al. “Removal of the laryngeal mask airway: factors affecting the incidence of post-operative adverse respiratory events in 300 patients”. European Journal of Anaesthesiology4 (1999): 251-256.


Citation: Peter Catalano., et al. “Comparing the Use of the Flexible Laryngeal Mask Airway Versus the Endotracheal Tube in Upper Airway Surgery".Acta Scientific Otolaryngology 4.6 (2022): 67-72.


Copyright: © 2022 Peter Catalano., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Acceptance rate34%
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Impact Factor0.871

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