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Ethnic considerations in the upper lip bite test: the reliability and validity of the upper lip bite test in predicting difficult laryngoscopy in Koreans.
BMC Anesthesiol. 2019 01 10; 19(1):9.BA

Abstract

BACKGROUND

Several methods have been used to predict difficult tracheal intubation. Among recently suggested methods, the upper lip bite test (ULBT) could serve as a good predictor. Soft tissue and skeletal hard tissue profiles are affected by many factors including ethnicity. We aimed to assess the clinical utility of the ULBT in Koreans while considering ethnic differences.

METHODS

Three-hundred-forty-four Korean patients undergoing general anesthesia with orotracheal intubation were included. Preoperatively, we recorded the patient's Modified Mallampati (MMT) classification, ULBT ratings, and the Cormack-Lehane grade.

RESULTS

The area under the receiver operating characteristic (ROC) curve (AUC) was lower for the ULBT than the MMT (95% confidence interval: 0.0697-0.191, p < 0.0001). The ULBT showed high accuracy (73.83%) and specificity (98.04%). On the other hand, the ULBT showed significantly lower sensitivity (4.49%). Only nine of 344 Korean patients could not bite their upper lip; among them, only three presented a difficult laryngoscopic view.

CONCLUSIONS

One factor related to the low sensitivity is the low incidence of a grade III ULBT in Koreans. In Asians, the scarcity of a grade III ULBT is explainable as a result of anteriorly displaced temporomandibular joints and redundant lip soft tissues. Despite its high specificity, the low sensitivity and AUC of the ULBT mean that the test results should be interpreted cautiously in Koreans. Ethnic differences should be considered when evaluating parameters related to soft tissues such as the ULBT.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT01908218, Date of registration JUL 2013.

Authors+Show Affiliations

Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13496, South Korea.Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13496, South Korea.Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13496, South Korea.Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13496, South Korea. iatria@hanmail.net.

Pub Type(s)

Journal Article
Validation Study

Language

eng

PubMed ID

30630419

Citation

Kim, Jong Chan, et al. "Ethnic Considerations in the Upper Lip Bite Test: the Reliability and Validity of the Upper Lip Bite Test in Predicting Difficult Laryngoscopy in Koreans." BMC Anesthesiology, vol. 19, no. 1, 2019, p. 9.
Kim JC, Ki Y, Kim J, et al. Ethnic considerations in the upper lip bite test: the reliability and validity of the upper lip bite test in predicting difficult laryngoscopy in Koreans. BMC Anesthesiol. 2019;19(1):9.
Kim, J. C., Ki, Y., Kim, J., & Ahn, S. W. (2019). Ethnic considerations in the upper lip bite test: the reliability and validity of the upper lip bite test in predicting difficult laryngoscopy in Koreans. BMC Anesthesiology, 19(1), 9. https://doi.org/10.1186/s12871-018-0675-5
Kim JC, et al. Ethnic Considerations in the Upper Lip Bite Test: the Reliability and Validity of the Upper Lip Bite Test in Predicting Difficult Laryngoscopy in Koreans. BMC Anesthesiol. 2019 01 10;19(1):9. PubMed PMID: 30630419.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ethnic considerations in the upper lip bite test: the reliability and validity of the upper lip bite test in predicting difficult laryngoscopy in Koreans. AU - Kim,Jong Chan, AU - Ki,Yumin, AU - Kim,Jihee, AU - Ahn,So Woon, Y1 - 2019/01/10/ PY - 2018/10/01/received PY - 2018/12/28/accepted PY - 2019/1/12/entrez PY - 2019/1/12/pubmed PY - 2020/1/24/medline SP - 9 EP - 9 JF - BMC anesthesiology JO - BMC Anesthesiol VL - 19 IS - 1 N2 - BACKGROUND: Several methods have been used to predict difficult tracheal intubation. Among recently suggested methods, the upper lip bite test (ULBT) could serve as a good predictor. Soft tissue and skeletal hard tissue profiles are affected by many factors including ethnicity. We aimed to assess the clinical utility of the ULBT in Koreans while considering ethnic differences. METHODS: Three-hundred-forty-four Korean patients undergoing general anesthesia with orotracheal intubation were included. Preoperatively, we recorded the patient's Modified Mallampati (MMT) classification, ULBT ratings, and the Cormack-Lehane grade. RESULTS: The area under the receiver operating characteristic (ROC) curve (AUC) was lower for the ULBT than the MMT (95% confidence interval: 0.0697-0.191, p < 0.0001). The ULBT showed high accuracy (73.83%) and specificity (98.04%). On the other hand, the ULBT showed significantly lower sensitivity (4.49%). Only nine of 344 Korean patients could not bite their upper lip; among them, only three presented a difficult laryngoscopic view. CONCLUSIONS: One factor related to the low sensitivity is the low incidence of a grade III ULBT in Koreans. In Asians, the scarcity of a grade III ULBT is explainable as a result of anteriorly displaced temporomandibular joints and redundant lip soft tissues. Despite its high specificity, the low sensitivity and AUC of the ULBT mean that the test results should be interpreted cautiously in Koreans. Ethnic differences should be considered when evaluating parameters related to soft tissues such as the ULBT. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01908218, Date of registration JUL 2013. SN - 1471-2253 UR - https://www.unboundmedicine.com/medline/citation/30630419/Ethnic_considerations_in_the_upper_lip_bite_test:_the_reliability_and_validity_of_the_upper_lip_bite_test_in_predicting_difficult_laryngoscopy_in_Koreans_ L2 - https://bmcanesthesiol.biomedcentral.com/articles/10.1186/s12871-018-0675-5 DB - PRIME DP - Unbound Medicine ER -