Predictive Value of Modified Mallampati Test and Upper Lip Bite Test Concerning Cormack and Lehane's Laryngoscopy Grading in the Anticipation of Difficult Intubation: A Cross-Sectional Study at a Tertiary Care Hospital, Bhubaneswar, India

Abstract

Background and objectiveMany tests are at hand to predict difficult intubation preoperatively to prevent morbidity and mortality of unanticipated difficult intubation. The present study was conducted to evaluate and compare the efficacy of the modified Mallampati test (MMT) and upper lip bite test (ULBT) to foresee difficult intubation. Materials and methodsAfter obtaining written informed consent, this prospective comparative observational study was conducted on 225 patients scheduled for elective surgery under general endotracheal anesthesia. Preoperative MMT and ULBT were performed. MMT Grade III, IV, and ULBT Grade IV were regarded as predictors of difficult intubation. The laryngoscopic view was graded as per Cormack and Lehane's laryngoscopic grading after induction of anesthesia by an experienced anesthesiologist ignorant of preoperative airway evaluation. Patients with Cormack and Lehane Class III and IV were regarded as difficult intubation. Sensitivity, specificity, and positive and negative predictive values of MMT and ULBT were computed. Agreement between two tests with the Cormack Lehane test was determined by the Kappa coefficient. ResultsIn our research, the occurrence of difficult intubation was found to be 10.2% (23 cases of difficult intubation out of 225 patients). In our analysis, we found the sensitivity (95.5% vs. 95.4%), specificity (54.8% vs 50.0%), positive predictive value (91.6% vs 93.1%), and negative predictive value (39.1% vs 39.1%) were almost comparable between modified Mallampati test and upper lip bite test. Kappa coefficient for the upper lip bite test (0.492) was slightly higher as compared to modified Mallampati scoring (0.454), but both the values are highly statistically significant (p-value <0.001). ConclusionBoth the upper lip bite test and modified Mallampati test are comparable with each other and since the upper lip bite test is easy to perform bedside test we recommend it to be used alone or in collaboration with other tests in assessing difficult airways.

Impact of Tracheobronchopathia Osteochondroplastica on Difficult Intubation

“… 2 , 3 , 5 In our patient, concurrent nasal pathology with elevated c‐ANCA titers suggests that additional manifestations of TPO may exist and is an important consideration during surgical planning to avoid morbidity and mortality. 4 In non‐emergent cases during elective procedures, maintenance of spontaneous ventilation and patient emergence from anesthesia should be a priority when considering possible TPO.…”

“…Symptoms of TPO are nonspecific and most commonly include chronic cough, wheezing, and dyspnea on exertion although clinical manifestations are highly variable and can lead to unanticipated difficult intubation in surgical settings 3 . Recognizing patients at risk of TPO is of utmost importance as failure to obtain a secure airway can result in significant complications 4 . Here, we present a case in which TPO was diagnosed after the inability to intubate during elective nasal endoscopy in the operating room.…”

“… 3 Recognizing patients at risk of TPO is of utmost importance as failure to obtain a secure airway can result in significant complications. 4 Here, we present a case in which TPO was diagnosed after the inability to intubate during elective nasal endoscopy in the operating room. This study was approved by the Johns Hopkins Institutional Review Board (IRB00366662).…”

Styletubation versus Laryngoscopy: A New Paradigm for Routine Tracheal Intubation

“…In addition to the traditional airway physical examinations [65][66][67], several other individual physical examination findings might be predictive but do not reliably exclude the likelihood for a difficult tracheal intubation by laryngoscopy. Among them, upper lip bite test (ULBT) is reported to be an accurate individual bedside clinical assessment [68][69][70][71][72]. Other individual tests that might be helpful to predict difficult airway include neck circumference, cervical spine mobility, hyomental distance, thyromental distance [73][74][75], sternomental distance [76], etc.…”

Comparison of Laryngoscopic Glottic Views Obtained via Macintosh vs Miller Blade in Adults Undergoing General Anesthesia with Endotracheal Intubation

“…6 Several tests are available that can be used to foresee the difficult laryngoscopy for example, Mallampati test, inter incisor gap, thyromental distance, mandibular rim length, mandible subluxation, chin protrusion & atlantooccipital extension and Cormack-Lehane (CL) grading system. 7,8 The CL grading system is extensively utilized to assess the glottic view obtained during laryngoscopy, wherein laryngoscopic view is categorized as Grade-I to -IV. [9][10][11] Based upon the laryngeal structure view through direct laryngoscopy, Cormack & Lehane put the Grade-I: when complete glottis is visible, Grade-II: when the posterior commissure of glottis is visible and Grade-III: when only the epiglottis is visible while Grade-IV: when any part of the laryngeal structure is not visible.…”