Journal of Dental Anesthesia and Pain Medicine

The Korean Dental Society of Anesthsiology (대한치과마취과학회)
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Effects of airway evaluation parameters on the laryngeal view grade in mandibular prognathism and retrognathism patients

  • Karm, Myong-Hwan (Department of Dental Anesthesiology, Seoul National University Dental Hospital) ;
  • Chi, Seong In (Department of Dental Anesthesiology, Seoul National University Dental Hospital) ;
  • Kim, Jimin (Department of Dental Anesthesiology, Seoul National University Dental Hospital) ;
  • Kim, Hyun Jeong (Department of Dental Anesthesiology, Seoul National University Dental Hospital) ;
  • Seo, Kwang-Suk (Department of Dental Anesthesiology, Seoul National University Dental Hospital) ;
  • Bahk, Jae-Hyon (Department of Anesthesiology and Pain Medicine, Seoul National University, College of Medicine) ;
  • Park, Chang-Joo (Division of Oral and Maxillofacial Surgery, Department of Dentistry, College of Medicine, Hanyang University)
  • Received : 2016.09.08
  • Accepted : 2016.09.22
  • Published : 2016.09.30
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Abstract

Background: Failure to maintain a patent airway can result in brain damage or death. In patients with mandibular prognathism or retrognathism, intubation is generally thought to be difficult. We determined the degree of difficulty of airway management in patients with mandibular deformity using anatomic criteria to define and grade difficulty of endotracheal intubation with direct laryngoscopy. Methods: Measurements were performed on 133 patients with prognathism and 33 with retrognathism scheduled for corrective esthetic surgery. A case study was performed on 89 patients with a normal mandible as the control group. In all patients, mouth opening distance (MOD), mandibular depth (MD), mandibular length (ML), mouth opening angle (MOA), neck extension angle (EXT), neck flexion angle (FLX), thyromental distance (TMD), inter-notch distance (IND), thyromental area (TMA), Mallampati grade, and Cormack and Lehane grade were measured. Results: Cormack and Lehane grade I was observed in 84.2%, grade II in 15.0%, and grade III in 0.8% of mandibular prognathism cases; among retrognathism cases, 45.4% were grade I, 27.3% grade II, and 27.3% grade III; among controls, 65.2% were grade I, 26.9% were grade II, and 7.9% were grade III. MOD, MOA, ML, TMD, and TMA were greater in the prognathism group than in the control and retrognathism groups (P < 0.05). The measurements of ML were shorter in retrognathism than in the control and prognathism groups (P < 0.05). Conclusions: Laryngoscopic intubation was easier in patients with prognathism than in those with normal mandibles. However, in retrognathism, the laryngeal view grade was poor and the ML was an important factor.

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References

  1. Caplan RA, Posner KL, Ward RJ, Cheney FW. Adverse respiratory events in anesthesia: A closed claims analysis. Anesthesiology 1990; 72: 828-33. https://doi.org/10.1097/00000542-199005000-00010
  2. Krohner RG. Anesthetic considerations and techniques for oral and maxillofacial surgery. Int Anesthesiol Clin 2003; 41: 67-89.
  3. Schmitt H, Buchfelder M, Radespeil-Troger M, Fahlbusch R. Difficult intubaton in acromegalic patients. Incidence and predictability. Anesthesiology 2000; 93: 110-4. https://doi.org/10.1097/00000542-200007000-00020
  4. Voyagis GS, Kyriakis KP, Dimitriou V, Vrettou I. Value of oropharyngeal mallampati classification in predicting difficult. Eur J Anaesthesiol 1998; 15: 330-4. https://doi.org/10.1097/00003643-199805000-00015
  5. Mallampati SR, Gatt SP, Gugino LD, Desai SP, Waraksa B, Liu PL, et al. A clinical sign to predict difficult tracheal intubation: A prospective. Can Anaesth Soc J 1985; 32: 429-34. https://doi.org/10.1007/BF03011357
  6. Frerk CM. Predicting difficult intubation. Anaesthesia 1991; 46: 1005-8. https://doi.org/10.1111/j.1365-2044.1991.tb09909.x
  7. Wilson ME, Spiegelhalter D, Robertson JA, Lesser P. Predicting difficult intubation. Br J Anaesth 1988; 61: 211-6. https://doi.org/10.1093/bja/61.2.211
  8. Lee A, Fan LTY, Gin T, Karmakar MK, Ngan Kee WD. A systematic review (meta-analysis) of the accuracy of the mallampati. Anesth Analg 2006; 102: 1867-78. https://doi.org/10.1213/01.ane.0000217211.12232.55
  9. Samsoon GL, Young JR. Difficult tracheal intubation: A retrospective study. Anaesthesia 1987; 42: 487-90. https://doi.org/10.1111/j.1365-2044.1987.tb04039.x
  10. Lee SJ, Kim HJ, Yum KW. Airway evaluation for endotracheal intubation of mandibular prognathic patient. J Korean Dent Soc Anesthesiol 2003; 3: 28-33. https://doi.org/10.17245/jkdsa.2003.3.1.28
  11. Cormack RS, Lehane J. Difficult tracheal intubation in obstetrics. Anaesthesia 1984; 39: 1105-11. https://doi.org/10.1111/j.1365-2044.1984.tb08932.x
  12. Julien F, Biebuyck MB, Phil D. Management of the difficult adult airway. Anaesthesiology 1991; 75: 1087-110. https://doi.org/10.1097/00000542-199112000-00021
  13. Tiret L, Desmonts JM, Hatton F, Vourc'h G. Complications associated with anaesthesia--a prospective survey in france. Can Anaesth Soc J 1986; 33: 336-44. https://doi.org/10.1007/BF03010747
  14. Bavitz JB, Collicott PE. Bilateral mandibular subcondylar fractures contributing to airway obstruction. Int J Oral Maxillofac Surg 1995; 24: 273-5. https://doi.org/10.1016/S0901-5027(95)80027-1
  15. Wilson ME, Spiegelhalter D, Robertson JA, Lesser P. Perdicting difficult intubation. Br J Anaesth 1988; 61: 211-6. https://doi.org/10.1093/bja/61.2.211
  16. Oates JDL, Macleod AD, Oates PD, Pearsall FJ, Howie JC, Murray GD. Comparison of two methods for predicting difficult intubation. Br J Anaesth 1991; 66: 305-9. https://doi.org/10.1093/bja/66.3.305
  17. Tham EJ, Gildersleve CD, Sanders LD, Mapleson WW, Vaughan RS. Effects of posture, phonation and observer on mallampati classification. Br J Anaesth 1992; 68: 32-8. https://doi.org/10.1093/bja/68.1.32
  18. Savva D. Prediction of difficult tracheal intubation. Br J Anaesth 1994; 73: 149-53. https://doi.org/10.1093/bja/73.2.149
  19. Ochroch EA, Hollander JE, Kush S, Shofer FS, Levitan RM. Assessment of laryngeal view: Percentage of glottic opening score vs cormack and lehane grading. Can J Anaesth 1999; 46: 987-90. https://doi.org/10.1007/BF03013137
  20. Katakura N, Umino M, Kubota Y. Morphologic airway changes after mandibular setback osteotomy for prognathism with and without cleft palate. Anesth Pain Control Dent 1993; 2: 22-6.
  21. Enacar A, Aksoy AU, Sencift Y, Haydar B, Aras K. Changes in hypopharyngeal airway space and in tongue and hyoid bone positions following the surgical correction of mandibular prognathism. Int J Adult Orthodon Orthognath Surg 1994; 9: 285-90.
  22. Kawamata A, Fujishita M, Ariji Y, Ariji E. Three-dimensional computed tomographic evaluation of morphologic airway changes after mandibular setback osteotomy for prognathism. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000; 89: 278-87. https://doi.org/10.1016/S1079-2104(00)70089-8
  23. Tselnik M, Pogrel MA. Assessment of the pharyngeal airway space after mandibular setback surgery. J Oral Maxillofac Surg 2000; 58: 282-5. https://doi.org/10.1016/S0278-2391(00)90053-3
  24. Singh PK, Prabhakar H. Airway management in a patient with occipital encephalocele with retrognathia and complete bilateral cleft palate. J Anesth 2008; 22: 335-6. https://doi.org/10.1007/s00540-008-0629-z

Cited by

  1. Letter to the Editor: Effects of airway evaluation parameters on the laryngeal view grade in mandibular prognathism and retrognathism patients vol.17, pp.1, 2016, https://doi.org/10.17245/jdapm.2017.17.1.77
  2. Authors' Reply to Letter to the Editor "Effects of airway evaluation parameters on the laryngeal view grade in mandibular prognathism and retrognathism patients" vol.17, pp.1, 2016, https://doi.org/10.17245/jdapm.2017.17.1.79