Abstract
BackgroundDifficult airway especially failed intubation has been associated with a high incidence of mortality and morbidity. Most of mortalities occur when an anaesthesiologist encounters an unanticipated difficult airway.FindingsIn 1999, a 23 yr. old, 65 kg weight and 170 cm height female patient had been scheduled for arthroscopy. Despite totally normal airway assessment (thyromental distance, mouth opening, jaw and neck movement ...) I was astonished by encountering a grade IV Cormack - Lehane laryngoscopic view. Tracheal intubation was impossible and ventilation was very difficult.On attempt to attain a better laryngoscopic view, while manipulating submandibular region I encountered a bulky noncompliant submental space (Submental Sign). This event made me more alert regarding this finding. Thereafter I noted for this sign throughout the past years and I found it very helpful.These findings encouraged me to write this report, and suggest a routine examination of submental space in order to keep the safety of the patient at the heart of the care we provide.ConclusionEvaluation of the submental space is suggested as an alternative predictor of difficult airway and routine examination of the submental space is of value in airway assessment.
Highlights
Difficult airway especially failed intubation has been associated with a high incidence of mortality and morbidity
Evaluation of the submental space is suggested as an alternative predictor of difficult airway and routine examination of the submental space is of value in airway assessment
Observation, palpation and evaluation of the submental space for more than ten years, as a routine examination in about 3 thousands patients with no skeleto-facial abnormality resulted in suggesting evaluation of the submental space as a routine examination before laryngoscopy in order to predict unexpected cases of difficult intubation
Summary
Difficult airway especially failed intubation has been associated with a high incidence of mortality and morbidity. In the case mentioned above, despite the absence of clinical criteria indicating difficult airway, in direct laryngoscopy I faced with a laryngoscopic view of class IV in the Cormack - Lehane classification. Observation, palpation and evaluation of the submental space for more than ten years, as a routine examination in about 3 thousands patients with no skeleto-facial abnormality resulted in suggesting evaluation of the submental space as a routine examination before laryngoscopy in order to predict unexpected cases of difficult intubation.
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