Extralaryngeal Complications in Laryngeal Microsurgeries: A Narrative Review

This narrative review aims to investigate extralaryngeal complications associated with laryngeal microsurgeries (LMS), focusing on their incidence, risk factors, and preventive strategies. Although LMS primarily target intralaryngeal pathologies, complications involving the teeth, oral mucosa, cranial nerves, and cardiovascular system can significantly impact postoperative recovery. A comprehensive literature search was conducted in PubMed, Scopus, Web of Science, Cochrane, Google Scholar and OVID databases, covering the past 20 years. Studies reporting on extralaryngeal complications such as dental trauma, mucosal injuries, nerve damage, and cardiovascular events during LMS were included. Relevant data on incidence, risk factors, and preventive measures were analyzed and synthesized narratively. The most frequently reported complications included dental injuries, mucosal trauma, and nerve damage—particularly involving the lingual, glossopharyngeal, and hypoglossal nerves. Cardiovascular complications, although rare, were also documented. Identified risk factors included pre-existing dental disease, prolonged surgical duration, and inadequate protection during suspension laryngoscopy or intubation. Most complications were minor and self-limiting, but some resulted in prolonged recovery or patient discomfort. Extralaryngeal complications in LMS are common but largely preventable. Strategies such as preoperative dental assessment, the use of protective mouthguards, minimizing suspension time, and appropriate anesthetic management are essential to reduce these risks. Further research is warranted to evaluate long-term outcomes and improve preventive approaches, especially in high-risk and pediatric populations. Methods: Relevant literature was reviewed to assess the frequency and nature of extralaryngeal complications in laryngeal microsurgeries. Studies reporting on dental trauma, mucosal injuries, nerve damage, and cardiovascular complications were included. Data regarding the incidence, risk factors, and recommended preventive measures were analyzed. Results: The most common complications identified were dental injuries, mucosal trauma, and nerve damage. Dental injuries were notably more frequent in patients with pre-existing dental conditions and occurred more often during perioperative intubation compared to suspension laryngoscopy. Mucosal injuries, such as erosions and hematomas, were also common, with most cases resolving spontaneously. Nerve injuries, particularly involving the lingual and hypoglossal nerves, were less frequent but led to prolonged recovery times in some patients. Cardiovascular events, although rare, were reported in certain cases, especially in high-risk patients. Conclusion: While most extralaryngeal complications in laryngeal microsurgeries are minor and self-limiting, they can significantly impact patient comfort and prolong recovery. Preventive strategies, including the use of protective dental devices, limiting suspension time, and optimizing anesthesia, are crucial in minimizing these risks. Future research should focus on refining surgical techniques and developing better preventive measures to further reduce the incidence of these complications.