Karm Myong-Hwan, Chi Seong In, Kim Jimin, Kim Hyun Jeong, Seo Kwang-Suk, Bahk Jae-Hyon, Park Chang-Joo
Department of Dental Anesthesiology, Seoul National University Dental Hospital, Seoul, Korea.
Department of Anesthesiology and Pain Medicine, Seoul National University, College of Medicine, Seoul, Korea.
J Dent Anesth Pain Med. 2016 Sep;16(3):185-191. doi: 10.17245/jdapm.2016.16.3.185. Epub 2016 Sep 30.
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.
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.
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).
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.
无法维持气道通畅可导致脑损伤或死亡。在下颌前突或后缩的患者中，一般认为插管困难。我们使用解剖学标准来定义和分级直接喉镜下气管插管的难度，从而确定下颌骨畸形患者气道管理的困难程度。
对133例计划进行美容矫正手术的前突患者和33例后缩患者进行测量。对89例下颌骨正常的患者进行病例研究作为对照组。测量所有患者的张口距离（MOD）、下颌深度（MD）、下颌长度（ML）、张口角度（MOA）、颈部伸展角度（EXT）、颈部屈曲角度（FLX）、甲状软骨至颏下距离（TMD）、切迹间距离（IND）、甲状软骨至颏下面积（TMA）、马兰帕蒂分级以及科马克和莱哈尼分级。
下颌前突病例中，84.2%为科马克和莱哈尼I级，15.0%为II级，0.8%为III级；后缩病例中，45.4%为I级，27.3%为II级，27.3%为III级；对照组中，65.2%为I级，26.9%为II级，7.9%为III级。前突组的MOD、MOA、ML、TMD和TMA大于对照组和后缩组（P < 0.05）。后缩组的ML测量值短于对照组和前突组（P < 0.05）。
前突患者的喉镜插管比下颌骨正常的患者更容易。然而，在后缩患者中，喉镜视野分级较差，且ML是一个重要因素。
