Which of the following parameters are assessed during preoperative airway assessment for a surgical patient? 1. Mouth opening 2. Ability to protrude the jaw 3. Thyromental distance 4. Cervicomental distance Select the correct answer using the code given below.
1, 2 and 3
The correct answer is 1, 2 and 3. Preoperative airway assessment predicts difficult mask ventilation, laryngoscopy and intubation. Mouth opening (inter-incisor distance) less than 3 cm hampers laryngoscope insertion. Ability to protrude the jaw, formalised as the upper lip bite test, reflects temporomandibular joint mobility; failure to bring the lower incisors in front of the upper predicts difficult laryngoscopy. Thyromental distance (thyroid notch to mentum, neck extended) assesses mandibular space for tongue displacement, abnormal below 6-6.5 cm. These accompany Mallampati grading, neck movement and dentition.
Cervicomental distance is not a validated routine parameter. The analogous accepted measure is the sternomental distance (abnormal below 12.5 cm), so statement 4 is the odd one out and every option containing it is excluded.
Key point: Recall inter-incisor greater than 3 cm, thyromental greater than 6.5 cm, sternomental greater than 12.5 cm, plus Mallampati III-IV and limited atlanto-occipital extension.
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