Left-molar Approach Improves the Laryngeal View in Patients with Difficult Laryngoscopy

Abstract

The left-molar approach with OELM improves the laryngeal view in patients with difficult laryngoscopy.

Reinke’s oedema of vocal cords’- Anaesthetic Considerations

“…Left molar approach for laryngoscopy improves direct glottic view using Macintosh blade. 5 This approach did not come to our mind at that time. Intubation using intubating laryngeal mask airway could have been the other option.…”

A comparison between left molar direct laryngoscopy and the use of a Bonfils intubation fibrescope for tracheal intubation in a simulated difficult airway

“…19,20 Both the BIF and LM approach (without adjuncts like a tube introducer) have been used independently in a simulated difficult airway with good success rates, 4,11 but studies are lacking regarding their relative efficacy. The molar approach to laryngoscopy reduces the distance from the patient's teeth to the larynx, minimizes the intrusion of maxillary structures into the line of view, and changes the line of vision from an oblique superoinferior direction to a horizontal lateromedial direction.…”

“…Consequently, a good glottic view can be obtained with minimal neck movement. 11,12 Additionally, the BIF approach does not require excessive manipulation of the cervical spine and has been found suitable for intubation in similar cases with a simulated difficult airway. 4 We had used an Ambu Perfit ACE collar with a wider chin portion, which significantly decreased the jaw excursion and mouth opening (Table 1) and created extremely challenging intubation conditions.…”

“…11 Cuvas et al showed that the LM approach improved the glottic view, but 81.5% of cases could not be intubated on the first attempt. 24 Bozdogan et al also found that the LM approach improved the view in 90% (18/20) of patients who had a difficult midline laryngoscopy, although tracheal intubation could not be performed in 35% (7/20) of these patients.…”

“…The molar approach to laryngoscopy reduces the distance from the patient's teeth to the larynx, minimizes intrusion of maxillary structures into the line of view, and changes the line of vision from an oblique superoinferior direction to a horizontal lateromedial direction. The glottic view is improved using a left molar (LM) approach; 11,12 however, it may be difficult to intubate with the tongue bulging on the medial side. 13 Intubation aids such as endotracheal tube introducers (long and thin with a curved tip) can be manipulated through the narrow space created during LM laryngoscopy and thus may improve the overall intubation success rate.…”