Can Mandibular Condylar Mobility Sonography Measurements Predict Difficult Laryngoscopy?

Yao, Wei‐Dong; Zhou, Yumei; Wang, Bin; Yu, Tao; Shen, Z. B.; Wu, Hao; Jin, Xiaoju; Li, Yuanhai

doi:10.1213/ane.0000000000001528

Cited by 50 publications

(49 citation statements)

References 25 publications

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“…Yao et al [4] used ultrasound to measure the distance moved by the condyle before and after the opening of the mouth to evaluate the degree of condyle mobility and applied it to the prediction of di cult laryngoscopy. The resulting AUC value of the ROC curve was 0.934, which is higher than those of the accurate measurement methods IID, ULBT grading, and Mallampati classi cation.…”

Section: Discussionmentioning

confidence: 99%

“…IID, ULBT, Mallampati classi cation, and other indicators that indirectly re ect the TMJ mobility have certain predictive value for di cult airways, but the accuracy and reliability of this prediction are still relatively limited [3] . Ultrasound measurement of the maximum movement distance of the condyle is thought to directly re ect the degree of TMJ mobility, and it can be effectively used for preoperative airway assessment [4] . However, this method is not simple and can not be effectively applied when patients wear protective equipment such as face masks.…”

Section: Introductionmentioning

confidence: 99%

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The value of a relatively safe method for predicting difficult laryngoscopy during the COVID-19 epidemic

Chen

et al. 2020

Preprint

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Background: The current global situation of COVID-19 epidemic is serious. Routine preoperative methods to assess airway such as the interincisor distance, Mallampati classification, and the upper lip bite test have a certain risk of upper respiratory tract exposure and virus spread. The condyle-tragus maximal distance can be used to assess the airway, and the assessment method does not require the patient to expose the upper respiratory tract, but its value in predicting difficult laryngoscopy compared to other indicators (Mallampati classification, interincisor distance, and upper lip bite test) remains unknown. The purpose of this study was to observe the value of condyle-tragus maximal distance to predict difficult laryngoscopy, and provide a new idea for preoperative airway assessment during epidemic. Methods: We enrolled adult patients who underwent general anesthesia and tracheal intubation. The interincisor distance, Mallampati test result, upper lip bite test result, and the condyle-tragus maximal distance of each patient were evaluated prior to the initiation of anesthesia. The primary outcome was difficult laryngoscopy defined as the Cormack-Lehane Level > grade 2. Results: A total of 304 patients were successfully included in the study ,39 patients were identified as difficult laryngoscopy. The correlation between the condyle-tragus maximal distance and Cormack-Lehane Level was the highest (Spearman correlation coefficient, -0.317; P＜0.001), and the area under the ROC curve was the highest (AUC：0.699,P＜0.01). The condyle-tragus maximal distance <1 finger width was the most consistent with difficult laryngoscopy (κ=0.485;99% CI,0.286-0.612) and its OR value was 10.09(95%CI: 4.19-24.28), sensitivity was 0.469(95%CI: 0.325-0.617), specificity was 0.929(95%CI: 0.877-0.964), positive predictive value was 0.676 (95%CI: 0.484-0.745), negative predictive value was 0.847(95%CI :0.825-0.865). Conclusion: Compared with the interincisor distance , Mallampati classification and the upper lip bite test, the condyle-tragus maximal distance has higher value in predicting difficult laryngoscopy, which can become a safer airway assessment method during the epidemic of COVID-19. Trial registration: The study was registered on October 21, 2019 in the Chinese Clinical Trial Registry (ChiCTR1900026775).

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The value of a relatively safe method for predicting difficult laryngoscopy during the COVID-19 epidemic

Chen

et al. 2020

Preprint

Self Cite

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show abstract

“…Ultrasound measurement of the maximum movement distance of the condyle is thought to directly re ect the degree of TMJ mobility. It can be effectively used for preoperative airway assessment [4] . However, this method, which need the help of ultrosound, is slightly complicated.…”

Section: Introductionmentioning

confidence: 99%

The value of a method to reduce the exposure of the upper respiratory tract for predicting difficult laryngoscopy

Wu¹,

Hu²,

Xu³

et al. 2020

Preprint

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Background: The current global situation of COVID-19 epidemic is serious. Routine preoperative methods to assess airway such as the interincisor distance(IID), Mallampati classification, and the upper lip bite test(ULBT) have a certain risk of upper respiratory tract exposure and virus spread. The condyle-tragus maximal distance(C-TMD) can be used to assess the airway, and the assessment method does not require the patient to expose the upper respiratory tract, but its value in predicting difficult laryngoscopy compared to other indicators (Mallampati classification, IID, and ULBT) remains unknown. The purpose of this study was to observe the value of C-TMD to predict difficult laryngoscopy and the influence on intubation time and intubation attempts, and provide a new idea for preoperative airway assessment during epidemic.Methods: We enrolled adult patients who underwent general anesthesia and tracheal intubation. The IID, Mallampati test result, ULBT result, and the C-TMD of each patient were evaluated prior to the initiation of anesthesia. The primary outcome were difficult laryngoscopy defined as the Cormack-Lehane Level > grade 2 , the number of intubation attempts and intubation time.Results: A total of 304 patients were successfully included in the study, 39 patients were identified as difficult laryngoscopy. The intubation time was shorter with the C-TMD ＞1 finger group 46.8±7.3s, compared with the C-TMD ＜1 finger group 50.8±8.6s (p＜0.01).First attempt success rate was higher in the C-TMD ＞1 finger group than in the C-TMD ＜1 finger group (P＜0.01).The correlation between the C-TMD and Cormack-Lehane Level was 0.317(Spearman correlation coefficient, P＜0.001), and the area under the ROC curve was 0.699(P＜0.01). The C-TMD <1 finger width was the most consistent with difficult laryngoscopy (κ=0.485;95%CI: 0.286-0.612) and its OR value was 10.09(95%CI: 4.19-24.28), sensitivity was 0.469(95%CI: 0.325-0.617), specificity was 0.929(95%CI: 0.877-0.964), positive predictive value was 0.676 (95%CI: 0.484-0.745), negative predictive value was 0.847(95%CI :0.825-0.865).Conclusion: Compared with the IID , Mallampati classification and ULBT, the C-TMD has higher value in predicting difficult laryngoscopy, which can become a more favorable airway assessment method during the epidemic of COVID-19.Trial registration: The study was registered on October 21, 2019 in the Chinese Clinical Trial Registry (ChiCTR1900026775).

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“…Regarding the perioperative setting, a rapidly growing body of evidence is emerging supporting the utility of POCUS. Perioperative point-of-care ultrasound (P-POCUS) has demonstrated utility for cardiovascular evaluation,4–7 pulmonary/airway8–12 and abdominal/gastric13 14 examinations. These works, among others, emphasize the concept that P-POCUS is a useful tool for all anesthesiologists.…”

Section: Introductionmentioning

confidence: 99%

Improved diagnostic accuracy of pathology with the implementation of a perioperative point-of-care ultrasound service: quality improvement initiative

Ramsingh

Runyon

Gatling

et al. 2019

Reg Anesth Pain Med

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IntroductionThe utility of perioperative point-of-care ultrasound (P-POCUS) is rapidly growing. The successful implementation of a comprehensive P-POCUS curriculum, Focused PeriOperative Risk Evaluation Sonography Involving Gastro-abdominal, Hemodynamic, and Trans-thoracic Ultrasound (FORESIGHT), has been demonstrated. This project sought to further evaluate the utility of P-POCUS with the following aims: (1) to assess the ability to train the FORESIGHT curriculum via a free, open-access, online platform; (2) to launch a P-POCUS clinical service as a quality improvement (QI) initiative; (3) to evaluate the diagnostic accuracy of the P-POCUS examinations to formal diagnostic studies; and (4) to compare the P-POCUS diagnostic accuracy with the diagnostic accuracy of traditional assessment (TA).MethodsThis study was launched as a QI project for the implementation of a P-POCUS service. A group of attending and resident anesthesiologists completed P-POCUS training supported by an online curriculum. After training, a P-POCUS service was launched. The P-POCUS service was available for any perioperative event, and specific triggers were also identified. All examinations were documented on a validated datasheet. The diagnostic accuracy of the two index tests, P-POCUS and TA, were compared with formal diagnostic testing. TA was defined as a combination of the anesthesiologist’s bedside assessment and physical examination. The primary outcome marker was a comparison in the accuracy of new diagnosis detected by P-POCUS service versus the TA performed by the primary anesthesiologist.ResultsA total of 686 P-POCUS examinations were performed with 466 examinations having formal diagnostic studies for comparison. Of these, 92 examinations were detected as having new diagnoses. Performance for detection of a new diagnosis demonstrated a statistically higher sensitivity for the P-POCUS examinations (p<0.0001). Performance comparison of all P-POCUS examinations that were matched to formal diagnostic studies (n=466) also demonstrated a significantly higher sensitivity. These findings were consistent across cardiovascular, pulmonary and abdominal P-POCUS categories (p<0.01). Additionally, multiple pathologies demonstrated complete agreement between the P-POCUS examination and the formal study.ConclusionA P-POCUS service can be developed after training facilitated by an online curriculum. P-POCUS examinations can be performed by anesthesiologists with a high degree of accuracy to formal studies, which is superior to TA.

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Can Mandibular Condylar Mobility Sonography Measurements Predict Difficult Laryngoscopy?

Abstract: Compared with indirect assessments, such as mouth opening and other parameters, mandibular condylar mobility, as assessed directly using sonography, was correlated with difficult laryngoscopy and demonstrated an independent and notably predictive property.

Cited by 50 publications

References 25 publications

The value of a relatively safe method for predicting difficult laryngoscopy during the COVID-19 epidemic

The value of a relatively safe method for predicting difficult laryngoscopy during the COVID-19 epidemic

The value of a method to reduce the exposure of the upper respiratory tract for predicting difficult laryngoscopy

Improved diagnostic accuracy of pathology with the implementation of a perioperative point-of-care ultrasound service: quality improvement initiative

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