J Dent Anesth Pain Med.  2016 Sep;16(3):185-191. 10.17245/jdapm.2016.16.3.185.

Effects of airway evaluation parameters on the laryngeal view grade in mandibular prognathism and retrognathism patients

Affiliations
  • 1Department of Dental Anesthesiology, Seoul National University Dental Hospital, Seoul, Korea. stone90@snu.ac.kr
  • 2Department of Anesthesiology and Pain Medicine, Seoul National University, College of Medicine, Seoul, Korea.
  • 3Division of Oral and Maxillofacial Surgery, Department of Dentistry, College of Medicine, Hanyang University, Seoul, Korea.

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.

Keyword

Airway; Intubation; Prognathism; Retrognathism

MeSH Terms

Airway Management
Brain
Congenital Abnormalities
Humans
Intubation
Intubation, Intratracheal
Laryngoscopy
Mandible
Mouth
Neck
Prognathism*
Retrognathia*
Surgery, Plastic

Figure

  • Fig. 1 To divide patients into 3 groups, i.e., prognathism, normal, and retrognathism, lateral cephalometric radiographs were used. Orthodontists decided which patients had an ANB angle below -1 in the prognathism group, above 4 in the retrognathism group, and between -1 and 4 in the normal group (Table 1). 1. Prognathism, 2. Normal, 3. Retrognathism. A (A point or subspinale): deepest point on maxillary alveolus, B (B point or supramentale): deepest point on mandibular alveolus.

  • Fig. 2 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).


Cited by  2 articles

Authors' Reply to Letter to the Editor “Effects of airway evaluation parameters on the laryngeal view grade in mandibular prognathism and retrognathism patients”
Myong-Hwan Karm, Kwang-Suk Seo
J Dent Anesth Pain Med. 2017;17(1):79-80.    doi: 10.17245/jdapm.2017.17.1.79.

Letter to the Editor: Effects of airway evaluation parameters on the laryngeal view grade in mandibular prognathism and retrognathism patients
Jaegyok Song
J Dent Anesth Pain Med. 2017;17(1):77-78.    doi: 10.17245/jdapm.2017.17.1.77.


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