Diagnostic Value of Upper Lip Bite Test combined with Hyomental Distance Ratio in assessing the airway
Article Sidebar
Abstract
INTRODUCTION
Airway assessment before any type of anesthesia is mandatory. Upper lip bite test (ULBT) is a relatively new test for assessing the airway. Range of freedom of mandible and dental architecture has a significant role in facilitating intubation, both of which are assessed by this single test. ULBT with good neck movements are sufficient criteria for assessing the airway. Hyomental distance ratio (HMDR) assesses the range of neck movements. So by combining these two tests we expect an increase in reliability and validity.
METHODS
Preoperatively we assessed the airway using ULBT, HMDR, and Mallampati (MP) tests of 300 patients. The anesthesiologist doing laryngoscopy is blinded to the results of pre op airway evaluation. Direct laryngoscopies are graded using the modified Cormack and Lehane scale. Difficult laryngoscopy was defined as Grade 3 or 4 view. ULBT class 3, and HMDR with optimal cutoff point 1.2 are considered as difficult intubation predictors. Sensitivity, Specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV) and Accuracy of both ULBT and HMDR separately and then both in combination are calculated and compared with those of MP.
RESULTS
ULBT:-Sensitivity - 88.2%, Specificity - 99.62%, PPV - 96.77%, NPV - 98.51%, Accuracy - 98.33%
HMDR: - Sensitivity - 88.2%, Specificity – 99.25%, PPV - 93.75%, NPV - 98.50%, Accuracy - 98.00%
MP: - Sensitivity - 17.65%, specificity - 88.72%, PPV - 16.67%, NPV - 89.39%, Accuracy - 80.66%
ULBT+HMDR: - Sensitivity - 82.35%, specificity-100%, PPV100%, NPV97.75%, Accuracy - 98.00 %
CONCLUSION
Upper Lip Bite test is good screening test for assessing the airway. ULBT in combination with HMDR increased the specificity and positive predictive value.
Full text article
Generated from XML file
References
[1] Randell T , “Prediction of difficult intubation", Acta Anaesthesiol Scand. 1996;40:1016-23.
https://www.ncbi.nlm.nih.gov/pubmed/8908216
[2] Zahid Hussain Khan, Shahriar Arbabi, "Diagnostic value of the upper lip bite test in predicting difficulty in intubation with head and neck landmarks obtained from lateral neck X‑ray", Indian Journal of Anaesthesia | Vol. 57 | Issue 4 |Jul-Aug 2013
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3800331/
[3] Apfelbaum JL, Hagberg CA, Caplan RA, Blitt CD, Connis RT, Nickinovich DG, et al. Practice guidelines for management of the difficult airway: An updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology 2013;118:251‑70.
https://www.ncbi.nlm.nih.gov/pubmed/23364566
[4] Schwartz DE, Matthay MA, Cohen NH. Death and other complications of emergency airway management in critically ill adults. A prospective investigation of 297 tracheal intubations. Anesthesiology 1995;82:367‑76.
https://www.ncbi.nlm.nih.gov/pubmed/7856895
[5] Caplan RA, Posner KL, Ward RJ, Cheney FW. Adverse respiratory events in anesthesia: A closed claims analysis. Anesthesiology 1990;72:828‑33.
https://www.ncbi.nlm.nih.gov/pubmed/2339799
[6] Shahid Husian Khan, Mahin Gharadaghil ,Ferozeh Nilli, Mehdi Ghiamat , Mostafa Mohammadi, “ Easy Endotracheal Intubation of a patient Suffering from Both Cushings and Nelsons syndromes predicted by the Upper lip bite test Despite a Mallampati Class 4 airway", Anesth Analg. 2007 Sep;105(3):786-7.
https://www.ncbi.nlm.nih.gov/pubmed/17717241
[7] Wilson ME, Spiegeihalter D,Robertson JA,Leasser P, "Predicting the Difficult Airway", BJA Education. 2015;15(5):253-257.
[8] Khan ZH, Kashfi A, Ebrahimkhani E, "A comparison of the upper lip bite test (a simple new technique) with modified Mallampati classification in predicting difficulty in endotracheal intubation: a prospective blinded study", Anesth Analg. 2003;96(2):595-9
https://www.ncbi.nlm.nih.gov/pubmed/12538218
[9] Carin A. Hagberg, MD, "Benumof’s Airway Management 2nd Edition. Chapter 1 - Functional Anatomy of the Airway", Robert G. Krohner, Sivam Ramanathan.
[10] Asai T, Matsumoto S, Fujise K, Johmura S, Shingu K. "Comparison of two Macintosh laryngoscope blades in 300 patients." Br J Anaesth 2003;90:457–60
https://academic.oup.com/bja/article/90/4/457/274334
[11] Rocke D.A.; Murray W.B.; Rout C.C.; Gouws E., "Relative risk analysis of factors associated with difficult intubation in obstetric anesthesia.", Anesthesiology (hagerstown). 1992:77(1): 67-73
[12] Mallampati SR, Gatt SP, Gugino LD, Desai SP, Waraksa B, Freiberger D, Liu PL., "A clinical sign to predict difficult tracheal intubation: a prospective study." Can Anaesth Soc J. 1985 Jul;32(4):429-34.
[13] Horton WA, Fahy L, Charters P: "Defining a standard intubating position using Angle Finder, British Journal of Anaesthesia 1989, 62:6¬12.
https://www.ncbi.nlm.nih.gov/pubmed/2917111
[14] Sawin PD, Todd MM, Traynelis VC, Farrell SB, Nader A, Sato Y, Clausen JD, Goel VK., "Cervical spine motion with direct laryngoscopy and orotracheal intubation. An in vivo cinefluoroscopic study of subjects without cervical abnormality." Anesthesiology. 1996 Jul;85(1):26-36.
[15] Türkan S, Ateş Y, Cuhruk H, Tekdemir I., "Should we reevaluate the variables for predicting the difficult airway in anesthesiology?" Anesth Analg. 2002 May;94(5):1340-4, table of contents.
[16] Wong SH, Hung CT. "Prevalence and prediction of difficult intubation in Chinese women." Anaesth Intensive Care 1999;27:49–52
[17] Oates JDL, Macleod AD, Oates PD, Pearsall FJ, Howie JC, Murray GD: "Comparison of two methods for predicting difficult intubation" British Journal of Anaesthesia 1991; 66:305¬309.
[18] Tse JC, Rimm EB, Hussain A. "Predicting difficult endotracheal intubation in surgical patients scheduled for general anesthesia: a prospective blind study." Anesth Analg 1995;81:254–8
https://www.ncbi.nlm.nih.gov/pubmed/7618711
[19] Cooke MS, Wei SH. "A comparative study of southern Chinese and British Caucasian cephalometric standards." Angle Orthod 1989;59:131–8
[20] Lee A, Fan LT, Gin T, Karmakar MK, Ngan Kee WD. "A systemic review (meta-analysis) of the accuracy of the Mallampati tests to predict the difficult airway." Anesth Analg 2006;102:1867–78
https://www.ncbi.nlm.nih.gov/pubmed/16717341
[21] Ezri T, Warters RD, Szmuk P, Saad-Eddin H, Geva D, Katz J, Hagberg C. "The incidence of class “zero” airway and the impact of Mallampati score, age, sex, and body mass index on prediction of laryngoscopy grade." Anesth Analg 2001;93:1073–5
[22] Al Ramadhani 5, Mohamed. LA, Rocke DA, et aI. "StemomentaI distance as the sole predictor of difficult laryngoscopy in obstetric anaesthesia." Br J Anaesth 1996;77:312-6.
[23] Yamamoto K, Tsubokawa T, Shibata K, et all. "Predicting difficult intubation with indirect laryngoscopy." Anesthesiology 1997;86:316;21
[24] TseIe, Rimm EB, Hussain A. "Predicting difficult endotracheal intubation in surgical patients scheduled for general anesthesia: a prospective blind study." Anesth Analg 1995;81:254-8.
https://www.ncbi.nlm.nih.gov/pubmed/7618711
[25] Gregory S. Voyagis.; and Kyriakos P. Kyriakis.; "The Effect of Goiter on Endotracheal Intubation," Anesth Analg 1997;84:611-2
[26] Ghai S. Hooda, R. Wadhera and N. Garg. "Gross TrachealDeviation : Airway Challenges And Concerns – Two Case Reports." A. Acta Anaesth. Belg., 2011, 62, 203-206
[27] Souza JW, Williams JT, Ayoub MM, Jerles ML, Dalton ML. "Bilateral recurrent nerve paralysis associated with multinodular substernal goiter: a case report." Am Surg. 1999;65:456–9.
[28] Shaha AR. "Airway management in anaplastic thyroid carcinoma." Laryngoscope. 2008 Jul;118(7):1195-8. doi: 10.1097/MLG.0b013e3181726d36.
https://www.ncbi.nlm.nih.gov/pubmed/18438260
[29] Khan ZH, Mohammadi M, Rasouli MR, Farrokhnia F, Khan RH., "The diagnostic value of the upper lip bite test combined with sternomental distance, thyromental distance, and interincisor distance for prediction of easy laryngoscopy and intubation: a prospective study." Anesth Analg. 2009 Sep;109(3):822-4.
https://www.ncbi.nlm.nih.gov/pubmed/19690252
[30] Arne J, Descoins P, Fusciardi J, Ingrand P, Ferrier B, Boudigues D, Aries J. "Preoperative assessment for difficult intubation in general and ENT surgery: predictive value of a clinical multivariate risk index." Br J Anaesth 1998;80:140–6.
https://www.ncbi.nlm.nih.gov/pubmed/9602574
[31] Merah NA, Wong DT, Foulkes-Crabbe DJ, Kushimo OT, Bode CO. "Modified Mallampati test, thyromental distance and interincisor gap are the best predictors of difficult laryngoscopy in West Africans." Can J Anaesth 2005;52:291–6
[32] Ali MA1, Qamar-ul-Hoda M, Samad K., "Comparison of upper lip bite test with Mallampati test in the prediction of difficult intubation at a tertiary care hospital of Pakistan.", J Pak Med Assoc. 2012 Oct;62(10):1012-5.
[33] Leopold H.J, Eberhart, Christian Arndt, "The Reliability and Validity of the Upper Lip Bite Test Compared with the Mallampati Classification to Predict Difficult Laryngoscopy: An external Prospective Evaluation." Anesth Analg 2005; 101:2849.
[34] R Bhat, S Mishra, A Badhe. "Comparison Of Upper Lip Bite Test And Modified Mallampati Classification In Predicting Difficult Intubation." The Internet Journal of Anesthesiology. 2006 Volume 13 Number 1.
[35] Elberhart LH, Arndt C, Cierpka T, Schwanekamp J, Wulf H, Putzke C. "The reliability and validity of the upper lip bite test with Mallampati classification to predict difficult laryngoscopy: an external prospective evaluation." Anesth Analg 2005; 101: 284-9.
[36] Myneni N, O'Leary AM, Sandison M, Roberts K. "Evaluation of the upper lip bite test in predicting difficult laryngoscopy." J Clin Anesth 2010; 22: 174-8
[37] Salimi A, Farzanegan B, Rastegarpour A, Kolahi AA. "Comparison of the upper lip bite test with measurement of thyromental distance for prediction of difficult intubations." Acta Anaesthesiol Taiwan 2008; 46: 61-5.
https://www.ncbi.nlm.nih.gov/pubmed/18593650
[38] E. Allahyary, S.R. Ghaemei, S. Azemati, "Comparison of six methods for predicting difficult intubation in obstetric patients" Department of Anesthesia, Shiraz University of Medical Sciences, Shiraz, Iran
[39] Takenaka I, Iwagaki T, Aoyama K, Ishimura H, Kadoya T., "Preoperative evaluation of extension capacity of the occipitoatlantoaxial complex in patients with rheumatoid arthritis: comparison between the Bellhouse test and a new method, hyomental distance ratio." Anesthesiology. 2006 Apr;104(4):680-5.
[40] Huh J, Shin HY, Kim SH, Yoon TK, Kim DK, "Diagnostic predictor of difficult laryngoscopy: the hyomental distance ratio." Anesth Analg. 2009 Feb;108(2):544-8. doi: 10.1213/ane.0b013e31818fc347.
https://www.ncbi.nlm.nih.gov/pubmed/19151285
https://www.ncbi.nlm.nih.gov/pubmed/8908216
[2] Zahid Hussain Khan, Shahriar Arbabi, "Diagnostic value of the upper lip bite test in predicting difficulty in intubation with head and neck landmarks obtained from lateral neck X‑ray", Indian Journal of Anaesthesia | Vol. 57 | Issue 4 |Jul-Aug 2013
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3800331/
[3] Apfelbaum JL, Hagberg CA, Caplan RA, Blitt CD, Connis RT, Nickinovich DG, et al. Practice guidelines for management of the difficult airway: An updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology 2013;118:251‑70.
https://www.ncbi.nlm.nih.gov/pubmed/23364566
[4] Schwartz DE, Matthay MA, Cohen NH. Death and other complications of emergency airway management in critically ill adults. A prospective investigation of 297 tracheal intubations. Anesthesiology 1995;82:367‑76.
https://www.ncbi.nlm.nih.gov/pubmed/7856895
[5] Caplan RA, Posner KL, Ward RJ, Cheney FW. Adverse respiratory events in anesthesia: A closed claims analysis. Anesthesiology 1990;72:828‑33.
https://www.ncbi.nlm.nih.gov/pubmed/2339799
[6] Shahid Husian Khan, Mahin Gharadaghil ,Ferozeh Nilli, Mehdi Ghiamat , Mostafa Mohammadi, “ Easy Endotracheal Intubation of a patient Suffering from Both Cushings and Nelsons syndromes predicted by the Upper lip bite test Despite a Mallampati Class 4 airway", Anesth Analg. 2007 Sep;105(3):786-7.
https://www.ncbi.nlm.nih.gov/pubmed/17717241
[7] Wilson ME, Spiegeihalter D,Robertson JA,Leasser P, "Predicting the Difficult Airway", BJA Education. 2015;15(5):253-257.
[8] Khan ZH, Kashfi A, Ebrahimkhani E, "A comparison of the upper lip bite test (a simple new technique) with modified Mallampati classification in predicting difficulty in endotracheal intubation: a prospective blinded study", Anesth Analg. 2003;96(2):595-9
https://www.ncbi.nlm.nih.gov/pubmed/12538218
[9] Carin A. Hagberg, MD, "Benumof’s Airway Management 2nd Edition. Chapter 1 - Functional Anatomy of the Airway", Robert G. Krohner, Sivam Ramanathan.
[10] Asai T, Matsumoto S, Fujise K, Johmura S, Shingu K. "Comparison of two Macintosh laryngoscope blades in 300 patients." Br J Anaesth 2003;90:457–60
https://academic.oup.com/bja/article/90/4/457/274334
[11] Rocke D.A.; Murray W.B.; Rout C.C.; Gouws E., "Relative risk analysis of factors associated with difficult intubation in obstetric anesthesia.", Anesthesiology (hagerstown). 1992:77(1): 67-73
[12] Mallampati SR, Gatt SP, Gugino LD, Desai SP, Waraksa B, Freiberger D, Liu PL., "A clinical sign to predict difficult tracheal intubation: a prospective study." Can Anaesth Soc J. 1985 Jul;32(4):429-34.
[13] Horton WA, Fahy L, Charters P: "Defining a standard intubating position using Angle Finder, British Journal of Anaesthesia 1989, 62:6¬12.
https://www.ncbi.nlm.nih.gov/pubmed/2917111
[14] Sawin PD, Todd MM, Traynelis VC, Farrell SB, Nader A, Sato Y, Clausen JD, Goel VK., "Cervical spine motion with direct laryngoscopy and orotracheal intubation. An in vivo cinefluoroscopic study of subjects without cervical abnormality." Anesthesiology. 1996 Jul;85(1):26-36.
[15] Türkan S, Ateş Y, Cuhruk H, Tekdemir I., "Should we reevaluate the variables for predicting the difficult airway in anesthesiology?" Anesth Analg. 2002 May;94(5):1340-4, table of contents.
[16] Wong SH, Hung CT. "Prevalence and prediction of difficult intubation in Chinese women." Anaesth Intensive Care 1999;27:49–52
[17] Oates JDL, Macleod AD, Oates PD, Pearsall FJ, Howie JC, Murray GD: "Comparison of two methods for predicting difficult intubation" British Journal of Anaesthesia 1991; 66:305¬309.
[18] Tse JC, Rimm EB, Hussain A. "Predicting difficult endotracheal intubation in surgical patients scheduled for general anesthesia: a prospective blind study." Anesth Analg 1995;81:254–8
https://www.ncbi.nlm.nih.gov/pubmed/7618711
[19] Cooke MS, Wei SH. "A comparative study of southern Chinese and British Caucasian cephalometric standards." Angle Orthod 1989;59:131–8
[20] Lee A, Fan LT, Gin T, Karmakar MK, Ngan Kee WD. "A systemic review (meta-analysis) of the accuracy of the Mallampati tests to predict the difficult airway." Anesth Analg 2006;102:1867–78
https://www.ncbi.nlm.nih.gov/pubmed/16717341
[21] Ezri T, Warters RD, Szmuk P, Saad-Eddin H, Geva D, Katz J, Hagberg C. "The incidence of class “zero” airway and the impact of Mallampati score, age, sex, and body mass index on prediction of laryngoscopy grade." Anesth Analg 2001;93:1073–5
[22] Al Ramadhani 5, Mohamed. LA, Rocke DA, et aI. "StemomentaI distance as the sole predictor of difficult laryngoscopy in obstetric anaesthesia." Br J Anaesth 1996;77:312-6.
[23] Yamamoto K, Tsubokawa T, Shibata K, et all. "Predicting difficult intubation with indirect laryngoscopy." Anesthesiology 1997;86:316;21
[24] TseIe, Rimm EB, Hussain A. "Predicting difficult endotracheal intubation in surgical patients scheduled for general anesthesia: a prospective blind study." Anesth Analg 1995;81:254-8.
https://www.ncbi.nlm.nih.gov/pubmed/7618711
[25] Gregory S. Voyagis.; and Kyriakos P. Kyriakis.; "The Effect of Goiter on Endotracheal Intubation," Anesth Analg 1997;84:611-2
[26] Ghai S. Hooda, R. Wadhera and N. Garg. "Gross TrachealDeviation : Airway Challenges And Concerns – Two Case Reports." A. Acta Anaesth. Belg., 2011, 62, 203-206
[27] Souza JW, Williams JT, Ayoub MM, Jerles ML, Dalton ML. "Bilateral recurrent nerve paralysis associated with multinodular substernal goiter: a case report." Am Surg. 1999;65:456–9.
[28] Shaha AR. "Airway management in anaplastic thyroid carcinoma." Laryngoscope. 2008 Jul;118(7):1195-8. doi: 10.1097/MLG.0b013e3181726d36.
https://www.ncbi.nlm.nih.gov/pubmed/18438260
[29] Khan ZH, Mohammadi M, Rasouli MR, Farrokhnia F, Khan RH., "The diagnostic value of the upper lip bite test combined with sternomental distance, thyromental distance, and interincisor distance for prediction of easy laryngoscopy and intubation: a prospective study." Anesth Analg. 2009 Sep;109(3):822-4.
https://www.ncbi.nlm.nih.gov/pubmed/19690252
[30] Arne J, Descoins P, Fusciardi J, Ingrand P, Ferrier B, Boudigues D, Aries J. "Preoperative assessment for difficult intubation in general and ENT surgery: predictive value of a clinical multivariate risk index." Br J Anaesth 1998;80:140–6.
https://www.ncbi.nlm.nih.gov/pubmed/9602574
[31] Merah NA, Wong DT, Foulkes-Crabbe DJ, Kushimo OT, Bode CO. "Modified Mallampati test, thyromental distance and interincisor gap are the best predictors of difficult laryngoscopy in West Africans." Can J Anaesth 2005;52:291–6
[32] Ali MA1, Qamar-ul-Hoda M, Samad K., "Comparison of upper lip bite test with Mallampati test in the prediction of difficult intubation at a tertiary care hospital of Pakistan.", J Pak Med Assoc. 2012 Oct;62(10):1012-5.
[33] Leopold H.J, Eberhart, Christian Arndt, "The Reliability and Validity of the Upper Lip Bite Test Compared with the Mallampati Classification to Predict Difficult Laryngoscopy: An external Prospective Evaluation." Anesth Analg 2005; 101:2849.
[34] R Bhat, S Mishra, A Badhe. "Comparison Of Upper Lip Bite Test And Modified Mallampati Classification In Predicting Difficult Intubation." The Internet Journal of Anesthesiology. 2006 Volume 13 Number 1.
[35] Elberhart LH, Arndt C, Cierpka T, Schwanekamp J, Wulf H, Putzke C. "The reliability and validity of the upper lip bite test with Mallampati classification to predict difficult laryngoscopy: an external prospective evaluation." Anesth Analg 2005; 101: 284-9.
[36] Myneni N, O'Leary AM, Sandison M, Roberts K. "Evaluation of the upper lip bite test in predicting difficult laryngoscopy." J Clin Anesth 2010; 22: 174-8
[37] Salimi A, Farzanegan B, Rastegarpour A, Kolahi AA. "Comparison of the upper lip bite test with measurement of thyromental distance for prediction of difficult intubations." Acta Anaesthesiol Taiwan 2008; 46: 61-5.
https://www.ncbi.nlm.nih.gov/pubmed/18593650
[38] E. Allahyary, S.R. Ghaemei, S. Azemati, "Comparison of six methods for predicting difficult intubation in obstetric patients" Department of Anesthesia, Shiraz University of Medical Sciences, Shiraz, Iran
[39] Takenaka I, Iwagaki T, Aoyama K, Ishimura H, Kadoya T., "Preoperative evaluation of extension capacity of the occipitoatlantoaxial complex in patients with rheumatoid arthritis: comparison between the Bellhouse test and a new method, hyomental distance ratio." Anesthesiology. 2006 Apr;104(4):680-5.
[40] Huh J, Shin HY, Kim SH, Yoon TK, Kim DK, "Diagnostic predictor of difficult laryngoscopy: the hyomental distance ratio." Anesth Analg. 2009 Feb;108(2):544-8. doi: 10.1213/ane.0b013e31818fc347.
https://www.ncbi.nlm.nih.gov/pubmed/19151285
Authors
Thankamony, D. H., S, H., & Venkitachalam, D. R. G. (2019). Diagnostic Value of Upper Lip Bite Test combined with Hyomental Distance Ratio in assessing the airway. Journal of Current Medical Research and Opinion, 2(12), 383–387. https://doi.org/10.15520/jcmro.v2i12.241
Copyright and license info is not available