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Background: The incidence of unanticipated difficult airway is 14.3-17.5% in obese. Preoperative difficult airway prediction is important to avoid postoperative morbidity and mortality. USG guided measurement of anterior neck soft tissue thickness can be used to predict difficult laryngoscopy in obese patients and we thus undertook this study to determine the role of USG guided measurement of anterior neck thickness at the level of vocal cords in difficult laryngoscopy prediction. Methods: Sixty obese patients (BMI≥30kg/m2), 18-70 years of age of either sex, were included. Anterior neck soft tissue thickness was measured by ultrasound as the distance from the skin to the anterior commissure of vocal cord. Neck circumference was measured at mid neck just below the laryngeal prominence with the subjects standing upright and facing forward with shoulders relaxed. Thyromental distance, sternomental distance, Mallampatti score and neck circumference were also recorded. Results: The cut off values of BMI (46.94 kg/m2), neck circumference (41.5 cm) and anterior neck soft tissue thickness (22.1mm). Four patients in the morbidly obese and 80% of the superobese patients had a difficult laryngoscopy. Sixteen (26.67%) patients had an anterior neck soft tissue thickness of >22.1mm. Of these, 11 (91.67%) patients had difficult laryngoscopy while one (8.33%) patient with anterior neck soft tissue thickness ≤ 22.1mm had difficult laryngoscopy (P<0.05). There was also significant association between neck circumference and BMI. Conclusion: The USG guided measurement of anterior neck soft tissue thickness, BMI and neck circumference can reliably predict difficult laryngoscopy in obese patients.

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