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Modified Mallampati test and thyromental distance as a predictor of difficult laryngoscopy in Thai patients.
J Med Assoc Thai. 2010 Jan; 93(1):84-9.JM

Abstract

BACKGROUND

Preoperative evaluation of anatomical landmarks and clinical factors are important in the detection of patients at risk for difficult laryngoscopy. The modified Mallampati test (MMT) and thyromental distance (TMD) are commonly used for this purpose but there are controversies regarding their accuracy.

OBJECTIVE

The objective of the present study was to evaluate the accuracy of MMT and TMD in the prediction of difficult laryngoscopy in Thai patients.

MATERIAL AND METHOD

1888 consecutive patients undergoing general anesthesia requiring endotracheal intubation were evaluated preoperatively using the MMT and TMD. The cut-off points for the difficult airway predictors were: Mallampati 3, 4 and TMD less than 6 cm. During direct laryngoscopy, the laryngeal view was graded using the Cormack and Lehane (CL) classification. CL grades III and IV were considered difficult laryngoscopy. Sensitivity and specificity for each airway predictor in isolation and in combination were determined.

RESULTS

The present study found Mallampati grade I 1050 patients (55.6%), grade II 730 patients (38.7%), grade III 104 patients (5.5%), grade IV 4 pateints (0.2%) and TMD less than 6 cm 85 patients (4.5%), TMD more than 6 cm 1803 patients (95.5%). Difficult laryngoscopy occurred in 60 patients (3.2%). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for the two airway predictors were: MMT 41.7%, 95.5%, 23.1% and 98.0% and TMD 23.3%, 96.1%, 16.5% and 97.4% respectively. The combination of two predictors with a sensitivity, specificity PPV and NPV were 55.0%, 92.3%, 19.1% and 98.4%.

CONCLUSION

MMT TMD and their combination are good predictors of difficult laryngoscopy in a Thai population.

Authors+Show Affiliations

Ittichaikulthol W
Department of Anesthesiology, Ramathibodi Hospital, Bangkok, Thailand.
Chanpradub S
No affiliation info available
Amnoundetchakorn S
No affiliation info available
Arayajarernwong N
No affiliation info available
Wongkum W
No affiliation info available

MeSH

AdolescentAdultAgedChi-Square DistributionFemaleHumansIntubation, IntratrachealLaryngoscopyLarynxLogistic ModelsMaleMiddle AgedPredictive Value of TestsSensitivity and SpecificityThailand

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20196416

Citation

Ittichaikulthol, Wichai, et al. "Modified Mallampati Test and Thyromental Distance as a Predictor of Difficult Laryngoscopy in Thai Patients." Journal of the Medical Association of Thailand = Chotmaihet Thangphaet, vol. 93, no. 1, 2010, pp. 84-9.
Ittichaikulthol W, Chanpradub S, Amnoundetchakorn S, et al. Modified Mallampati test and thyromental distance as a predictor of difficult laryngoscopy in Thai patients. J Med Assoc Thai. 2010;93(1):84-9.
Ittichaikulthol, W., Chanpradub, S., Amnoundetchakorn, S., Arayajarernwong, N., & Wongkum, W. (2010). Modified Mallampati test and thyromental distance as a predictor of difficult laryngoscopy in Thai patients. Journal of the Medical Association of Thailand = Chotmaihet Thangphaet, 93(1), 84-9.
Ittichaikulthol W, et al. Modified Mallampati Test and Thyromental Distance as a Predictor of Difficult Laryngoscopy in Thai Patients. J Med Assoc Thai. 2010;93(1):84-9. PubMed PMID: 20196416.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Modified Mallampati test and thyromental distance as a predictor of difficult laryngoscopy in Thai patients. AU - Ittichaikulthol,Wichai, AU - Chanpradub,Suwanna, AU - Amnoundetchakorn,Sakda, AU - Arayajarernwong,Niramon, AU - Wongkum,Wilailux, PY - 2010/3/4/entrez PY - 2010/3/4/pubmed PY - 2010/5/5/medline SP - 84 EP - 9 JF - Journal of the Medical Association of Thailand = Chotmaihet thangphaet JO - J Med Assoc Thai VL - 93 IS - 1 N2 - BACKGROUND: Preoperative evaluation of anatomical landmarks and clinical factors are important in the detection of patients at risk for difficult laryngoscopy. The modified Mallampati test (MMT) and thyromental distance (TMD) are commonly used for this purpose but there are controversies regarding their accuracy. OBJECTIVE: The objective of the present study was to evaluate the accuracy of MMT and TMD in the prediction of difficult laryngoscopy in Thai patients. MATERIAL AND METHOD: 1888 consecutive patients undergoing general anesthesia requiring endotracheal intubation were evaluated preoperatively using the MMT and TMD. The cut-off points for the difficult airway predictors were: Mallampati 3, 4 and TMD less than 6 cm. During direct laryngoscopy, the laryngeal view was graded using the Cormack and Lehane (CL) classification. CL grades III and IV were considered difficult laryngoscopy. Sensitivity and specificity for each airway predictor in isolation and in combination were determined. RESULTS: The present study found Mallampati grade I 1050 patients (55.6%), grade II 730 patients (38.7%), grade III 104 patients (5.5%), grade IV 4 pateints (0.2%) and TMD less than 6 cm 85 patients (4.5%), TMD more than 6 cm 1803 patients (95.5%). Difficult laryngoscopy occurred in 60 patients (3.2%). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for the two airway predictors were: MMT 41.7%, 95.5%, 23.1% and 98.0% and TMD 23.3%, 96.1%, 16.5% and 97.4% respectively. The combination of two predictors with a sensitivity, specificity PPV and NPV were 55.0%, 92.3%, 19.1% and 98.4%. CONCLUSION: MMT TMD and their combination are good predictors of difficult laryngoscopy in a Thai population. SN - 0125-2208 UR - https://www.unboundmedicine.com/medline/citation/20196416/Modified_Mallampati_test_and_thyromental_distance_as_a_predictor_of_difficult_laryngoscopy_in_Thai_patients_ DB - PRIME DP - Unbound Medicine ER -