Department of Anesthesiology and Reanimation, Faculty of Medicine, Ege University, İzmir, Turkey.
Turk J Med Sci. 2022 Jun;52(3):730-740. doi: 10.55730/1300-0144.5367. Epub 2022 Jun 16.
The aim of this study is to research the incidence of difficult airways and the effectiveness of anthropometric measurements and clinical tests used to predict difficult airways in patients undergoing head and neck surgery.
This study was performed on a total of 200 patients over the age of 18 who underwent head and neck surgery between December 2019 and March 2020. The demographic data of the patients in the preoperative period, previous operations/ radiotherapy history applied to the head and neck region, and obstructive sleep apnea syndrome symptoms were recorded. In the physical examination, the jaw structure, mouth opening, jaw movement, and tooth structure of the patients, modified Mallampati classification, head and neck movements, neck circumference, thyromental and sternomental distance, atlantooccipital joint mobility, upper lip bite test, Wilson risk scoring, and Cormack-Lehane classification were evaluated.
The difficult laryngoscopy rate was identified as 19%, and the difficult intubation rate as 8%. Operation history related to head and neck (p = 0.002), presence of at least two of the obstructive sleep apnea syndrome symptoms (p = 0.008), Modified Mallampati score (p = 0.009), Wilson risk score (p = 0.004), upper lip bite test (p < 0.0001) and mouth opening (p = 0.001) were found to be associated with difficult laryngoscopy. Modified Mallampati score (p = 0.002), Wilson risk score (p < 0.0001), upper lip bite test (p < 0.0001), mouth opening (p < 0.0001), sternomental distance (p = 0.003), Atlantooccipital joint mobility (p = 0.001), and Cormack-Lehane classification (p < 0.0001) were found to be associated with difficult intubation. According to multiple logistic regression analysis, the results obtained for sternomental distance and mouth opening were OR 0.8, 95% CI 0.6-1.1 and OR 0.2, 95% CI 0.1-0.4, respectively.
In patients who underwent head and neck surgery, it was observed that the frequency of difficult airway was higher, and particularly the Modified Mallampati score, Wilson risk score, upper lip bite test, and mouth opening were associated with both difficult laryngoscopy and difficult intubation.
本研究旨在研究行头颈部手术患者中困难气道的发生率，以及用于预测困难气道的人体测量学测量和临床检查的有效性。
本研究共纳入 200 例年龄在 18 岁以上、行头颈部手术的患者。记录患者术前的人口统计学数据、头颈部既往手术/放疗史、阻塞性睡眠呼吸暂停综合征症状。在体格检查中，评估患者的下颌结构、张口度、下颌运动、牙齿结构、改良 Mallampati 分级、头颈部运动、颈围、甲状软骨-颏下距离、寰枕关节活动度、上唇咬诊、Wilson 风险评分和 Cormack-Lehane 分级。
困难喉镜检查率为 19%，困难插管率为 8%。与头颈部相关的手术史（p=0.002）、至少存在 2 项阻塞性睡眠呼吸暂停综合征症状（p=0.008）、改良 Mallampati 评分（p=0.009）、Wilson 风险评分（p=0.004）、上唇咬诊（p<0.0001）和张口度（p=0.001）与困难喉镜检查相关。改良 Mallampati 评分（p=0.002）、Wilson 风险评分（p<0.0001）、上唇咬诊（p<0.0001）、张口度（p<0.0001）、胸骨上切迹-颏下距离（p=0.003）、寰枕关节活动度（p=0.001）和 Cormack-Lehane 分级（p<0.0001）与困难插管相关。根据多因素逻辑回归分析，胸骨上切迹-颏下距离和张口度的结果分别为 OR 0.8，95%CI 0.6-1.1 和 OR 0.2，95%CI 0.1-0.4。
在接受头颈部手术的患者中，发现困难气道的发生率较高，特别是改良 Mallampati 评分、Wilson 风险评分、上唇咬诊和张口度与喉镜检查和插管均相关。
