The Upper Lip Bite Test to Predict Difficult Intubation

Abstract

To the Editor: In a recent report, the upper lip bite test was used to correctly predict an easy intubation in a patient with Cushing's and Nelson's syndromes.1 Their article describes the oropharyngeal image in Figure 2 as a Class IV airway, using the Samsoon and Young modification of Mallampati classification. The published image is incorrect, as the lower lip is still visible because the tongue has not been maximally protruded.2 Bedside airway screening tests must be reliable and quick to perform. The use of single screening tests for difficult intubation3 is associated with low Positive Predictive Value (the proportion of cases predicted to be difficult, who actually were difficult), but it is crucial that whichever assessment is used, it must be performed correctly. Finally, forward movement of the mandible according to the position of the lower incisors in relation to the upper incisors, has previously been published in this Journal.4,5 Jeffrey L. Tong, FRCA Academic Department of Military Anaesthesia Royal Centre for Defence Medicine Birmingham UK [email protected] Andrea J. Gait, FRCA Department of Anaesthesia Birmingham Heartlands Hospital Birmingham UK