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. 2016 Jan;20(1):3-8.
doi: 10.4103/0972-5229.173678.

Comparison of upper lip bite test and ratio of height to thyromental distance with other airway assessment tests for predicting difficult endotracheal intubation

Jigisha Prahladrai Badheka  1 , Pratik M Doshi  1 , Ashutosh M Vyas  1 , Nirav Jentilal Kacha  1 , Vandana S Parmar  1
Affiliations

Comparison of upper lip bite test and ratio of height to thyromental distance with other airway assessment tests for predicting difficult endotracheal intubation

Jigisha Prahladrai Badheka et al. Indian J Crit Care Med. 2016 Jan.

Abstract

Background: Various anatomical measurements and noninvasive clinical tests, singly or in various combinations can be performed to predict difficult intubation. Upper lip bite test (ULBT) and ratio of height to thyromental distance (RHTMD) are claimed to have high predictability. Hence, we have conducted this study to compare the predictive value of ULBT and RHTMD with the following parameters: Mallampati grading, inter-incisor gap, thyromental distance, sternomental distance, head and neck movements, and horizontal length of mandible for predicting difficult intubation.

Materials and methods: In this single blinded, prospective, observational study involving 170 adult patients of either sex belonging to American Society of Anesthesiologists physical Status I-III scheduled to undergo general anesthesia were recruited. All patients were subjected to the preoperative airway assessment and, the above parameters were recorded correlated with Cormack and Lehane grade and analyzed. The number of intubation attempts and use of intubation aids were also noted.

Results: ULBT and RHTMD had highest sensitivity (96.64%, 90.72%), specificity (82.35%, 80.39%), positive predictive value (92.74%, 91.53%), and negative predictive value (91.3%, 78.8%), respectively, compared to other parameters. While odds ratio and likelihood ratio >1 for all the tests.

Conclusion: ULBT can be used as a simple bedside screening test for prediction of difficult intubation, but it should be combined with other airway assessment tests for better airway predictability. RHTMD can also be used as an acceptable alternative.

Keywords: Airway assessment tests; difficult laryngoscopy; ratio of height to thyromental distance; upper lip bite tests.

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Figures

Figure 1
Figure 1
(a) Mallampati grading, and (b) Cormack and Lehane laryngoscopy grading. Rapid airway access Sérgio L. Amantéa I; Jefferson P. Piva II; Malba Inajá Rodrigues III; Francisco Bruno IV; Pedro Celiny R. GarciaV Print version ISSN 0021-7557 J. Pediatr. (Rio J.) vol. 79 suppl.2 Porto Alegre Nov. 2003
Figure 2
Figure 2
(a) Upper lip bite test, and (b) thyromental distance. Image courtesy: Comparative evaluation of airway assessment tests and their correlation with laryngoscopy. Sharma et al.: Indian Journal of Clinical Anesthesia, January–March 2015;2(1):19–26)
Figure 3
Figure 3
Comparison of various predictive tests
See this image and copyright information in PMC

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