Laryngeal Axes Research Articles

A magnetic resonance imaging (MRI) study of changes in the angle between the tracheal and laryngeal axes in the sniffing, neutral and extended head and neck positions

Background; Although the sniffing position has historically been used for conventional laryngoscopy, the ideal position for videolaryngoscopy is yet to be elucidated. When a hyperangulated blade is utilised in videolaryngoscopy, despite improved glottic visualisation, the acute angle between the laryngeal and tracheal axes results in the inability to advance the tube into the trachea. We hypothesise that the position that produces the smallest angle between the laryngeal and tracheal axes would most likely facilitate passage of a tube into the trachea during videolaryngoscopy using a hyperangulated blade. Methods20 healthy young adult volunteers underwent magnetic resonance imaging scanning in three anatomic positions: head in the neutral position, in the sniffing position and in the extended position. In total 60 T2-weighted sagittal magnetic resonance images were obtained and the following measurements were made: angle A (the angle between the laryngeal and tracheal axes), angle B (the angle between the laryngeal and pharyngeal axes), angle C (the angle between the pharyngeal and oral axes), angle D (the angle between the laryngeal axis and line of vision) and angle E (the angle between the line of vision and pharyngeal axis). ResultsMean (SD) angle A (in ◦) in neutral, sniffing and extended positions were 20.7 (6.8), 10.8 (6.9) and 30.5 (5.2) with p < 0.001. Angle A and C were significantly reduced when the head position was shifted from neutral to sniffing position. Angle D was smallest in the extended position. The difference in all five angles in three positions was statistically significant (p < 0.001). ConclusionAngle A was smallest in the sniffing position, therefore this position is most likely produce a better alignment between laryngeal and tracheal axes.

Comparison of Macintosh, McCoy, Truview EVO2, and King Vision Laryngoscopes for Intubation in Patients with Immobilized Cervical Spine

Abstract Background: Immobilization of the neck in cervical spine injury patients can lead to misalignment of the oral, pharyngeal, and laryngeal axis, thereby making intubation more difficult. The principal aim of our study was to compare the efficacy of King Vision, Truview Evo2, and McCoy with Macintosh laryngoscope in patients getting intubated with cervical spine immobilized using manual inline stabilization. Materials and Methods: This was a randomized, controlled trial of 160 patients who were randomized to undergo surgery under general anesthesia with endotracheal intubation. We equally divided the subjects into using either Macintosh, McCoy, Truview Evo2, and King Vision laryngoscopes to facilitate intubation. We evaluated the intubation difficulty using the Intubation Difficulty Score (IDS) and Cormack–Lehane grading. Results: King Vision, Truview Evo2, and McCoy reduced the IDS as compared to Macintosh (P &lt; 0.001). King Vision showed a first-attempt success rate of 100%. Cormack and Lehane's glottic views were best with King Vision followed by Truview Evo2 and there was much less need for external manipulation as compared to McCoy and Macintosh. Time taken for intubation was least with McCoy blade (22.9 ± 7.2 s, P &lt; 0.001). Conclusion: The use of both King Vision and Truview Evo2 significantly resulted in a decreased the IDS and improved Cormack–Lehane grading as compared to Macintosh and McCoy.

DIFFICULT INTUBATION AT BAY! C-MAC FAILS TO PAY!! CRITICAL POSITIONING PAVES THE WAY!!!, DIFFICULT INTUBATION IN A CASE OF OBSTRUCTIVE HYDROCEPHALUS POSTED FOR V.P. SHUNT

Children with gross hydrocephalus present various challenges to the anaesthesiologists. The problems encountered are not only limited to associated congenital abnormalities and physiological derangements due to raised intra cranial tension, even intubation in such cases can pose great difculty owing to the increased head circumference that makes the alignment of oro-pharyngo- [1,3] laryngeal axis under direct laryngoscopy almost impossible . Difcult airway cart, C- MAC, paediatric breoptic bronchioscope and all possible difcult airway armamentarium must be checked to be in place before induction of anaesthesia in such cases to potentially avoid any [2] airway disaster . Here is a case report of a child with gross hydrocephalus posted for emergency VP shunt placement that turned out to be an extremely challenging airway.

A comparative evaluation of Airtraq and Hansraj Video laryngoscopes in patients undergoing tracheal intubation with cervical spine immobilization - A randomized prospective study.

Background and Aims:Airway management is a key concern in trauma patients with cervical spine fracture. Application of manual inline axial stabilization (MIAS) has become the standard of care in these patients. Indirect laryngoscopy only requires alignment of the pharyngeal and laryngeal axis. Hence the primary objective of the study was to compare two indirect laryngoscopes, Airtraq (with adaptor) and Hansraj Video laryngoscopes based on its Intubation Difficulty Score.Material and Methods:Sixty anesthetized patients were divided into two groups using computer-based randomization, and tracheal intubation was performed using either Airtraq or Hansraj Videolaryngoscope with cervical spine immobilization.Results:Both Airtraq and Hansraj groups were comparable in terms of percentage of glottic opening (POGO) scoring (92 ± 9.88% vs. 89.3 ± 10.4%.) and duration of intubation attempt (14.9 ± 4.36 sec vs. 16.97 ± 3.64 sec). Intubation difficulty scale (IDS) score was significantly shorter with Airtraq (1 ± 0.58 vs. 1.8 ± 0.805; P < 0.0001). The mean duration of time taken for laryngoscopy in Airtraq (12.9 ± 2.07 s vs. 19.06 ± 3.83 s; P < 0.0001)) was significantly shorter and also the duration of time taken to secure airway in Airtraq VL was significantly shorter (29.47 ± 4.75 s vs. 36.03 ± 5.80 sec; P < 0.0001). The heart rate and MABP changes were modest in both groups, but was significantly more in Hansraj VL as compared to Airtraq VL, post-intubation.Conclusion:Both Airtraq and Hansraj videolaryngoscope can be used as first-hand device in the scenario of cervical spine stabilization. Airtraq videolaryngoscope is better than Hansraj videolaryngoscope due to shorter IDS and lessor hemodynamic changes.

Haemodynamic responses following orotracheal intubation in patients with hypertension---Macintosh direct laryngoscope versus Glidescope®videolaryngoscope.

Background and Aims:Glidescope®videolaryngoscope (GVL) is a video intubation system with 60° angle blade that provides excellent laryngeal view, does not require alignment of oral, pharyngeal, and laryngeal axes for visualisation of glottis, thus causing less stimulation of orolaryngopharynx. The aim of this study was to compare haemodynamic responses (blood pressure and heart rate) and airway morbidity using the Macintosh direct laryngoscope (MDL) and the Glidescope®videolaryngoscope (GVL) in hypertensive patients.Methods:Fifty patients with hypertension controlled on antihypertensive medications scheduled for elective surgery under general anaesthesia were randomly assigned to group GVL (n = 25) or group MDL (n = 25). Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MBP) were recorded at baseline, after induction, pre-intubation, at intubation, 1, 2, 3, 4, and 5 min after intubation. Time to intubation, number of attempts, complications during intubation, and postoperative airway complications (sore throat, hoarseness, dysphagia, and cough) were also recorded.Results:There was a statistically significant increase in SBP, DBP, and MBP at intubation [(P = 0.003, 0.013, 0.03), 1 min (P = 0.001, 0.012, 0.02), 2 min (P = 0.04, 0.02, 0.04), and 3 min (P = 0.02, 0.01)] in the MDL group as compared to GVL group. The time to intubate was significantly greater in the GVL group as compared to MDL group (P = 0.0006). There was no significant difference in the incidence of intraoperative and postoperative airway complications.Conclusion:In the hands of an experienced anaesthesiologist, the use of GVL in controlled hypertensive patients is associated with less haemodynamic response as compared to Macintosh Laryngoscope without any increase in airway complications.

Comparison of glottis views with fixed-height pillow versus adjustable-pillow height by pressure infusion bag for successful intubation

Background: This study aimed to get optimal sniffing position for successful intubation rate and measuring intubation time. The classical rationale for the sniffing position is that the alignment of the mandibular axis, pharyngeal axis, and laryngeal axis is facilitated, permitting successful direct laryngoscopy. Patients and Methods: A total of 100 patients without any anticipated difficult airway were enrolled after informed consent is given. After induction of anesthesia, patients were randomly divided into two groups. In Group PB, a deflated pressure infusion bag was put under the nape of the neck and occiput. The anesthetist performed laryngoscopy with the left hand while inflating the bag with the right hand up to the best glottic view without external pressure is achieved. The height of the bag was measured. In Group PI, 10-cm fixed-height noncompressible pillow was placed behind the head up to the shoulder. The best glottic view of the entire glottis without external pressure was noticed. Grading of glottic opening grade, SPO2, intubation time, and intubation trials were also noted. Results: Failure to intubate was noted in one patient in Group PB and two in Group PI. Intubations successful in 45 (90%) patients in Group PB as compared to 38 (76%) patients in Group PI (P < 0.05). Laryngoscopic view in Group PB was superior to that with Group PI (P < 0.05), with mean pressure bag height of 4.86 cm. Conclusion: The use of pressure infusion bag for adjustable-pillow height provides more success in intubation condition by head elevated position than the fixed height of 10 cm.

Comprehensive Overview of Pediatric Airway Management

Pediatric endotracheal intubation is a procedure that can be stress provoking to the emergency physician. Although the need for this core skill is rare, when confronted with this situation, the emergency physician must have knowledge of the anatomic, physiologic, and pathologic components unique to the pediatric airway to optimize success. Furthermore, the emergency physician should be well versed in the various equipment and adjuncts as well as techniques developed to effectively manage the pediatric airway. This review covers the pathophysiology and practice of endotracheal intubation. Figures show a gum elastic bougie; the Mallampati classification; appropriate oropharyngeal, laryngeal, and tracheal axes; advancing the laryngoscope to lift the epiglottis; endotracheal tube position in neonates; and synchronized intermittent mandatory ventilation pressure-regulated volume control mechanical ventilation. Tables list endotracheal tube sizes, neonatal endotracheal tube sizes, pediatric laryngeal mask airway sizes, commonly used induction agents, and endotracheal tube insertion depth guidelines. This review contains 6 figures, 8 tables, and 77 references. Key words: emergent tracheal intubation; endotracheal tube; laryngoscopy; pediatric airway; pediatric airway management; pediatric endotracheal intubation; pediatric laryngeal mask; video laryngoscopy

Comprehensive Overview of Pediatric Airway Management

Pediatric endotracheal intubation is a procedure that can be stress provoking to the emergency physician. Although the need for this core skill is rare, when confronted with this situation, the emergency physician must have knowledge of the anatomic, physiologic, and pathologic components unique to the pediatric airway to optimize success. Furthermore, the emergency physician should be well versed in the various equipment and adjuncts as well as techniques developed to effectively manage the pediatric airway. This review covers the pathophysiology and practice of endotracheal intubation. Figures show a gum elastic bougie; the Mallampati classification; appropriate oropharyngeal, laryngeal, and tracheal axes; advancing the laryngoscope to lift the epiglottis; endotracheal tube position in neonates; and synchronized intermittent mandatory ventilation pressure-regulated volume control mechanical ventilation. Tables list endotracheal tube sizes, neonatal endotracheal tube sizes, pediatric laryngeal mask airway sizes, commonly used induction agents, and endotracheal tube insertion depth guidelines. This review contains 6 figures, 8 tables, and 77 references. Key words: emergent tracheal intubation; endotracheal tube; laryngoscopy; pediatric airway; pediatric airway management; pediatric endotracheal intubation; pediatric laryngeal mask; video laryngoscopy

Comprehensive Overview of Pediatric Airway Management

Pediatric endotracheal intubation is a procedure that can be stress provoking to the emergency physician. Although the need for this core skill is rare, when confronted with this situation, the emergency physician must have knowledge of the anatomic, physiologic, and pathologic components unique to the pediatric airway to optimize success. Furthermore, the emergency physician should be well versed in the various equipment and adjuncts as well as techniques developed to effectively manage the pediatric airway. This review covers the pathophysiology and practice of endotracheal intubation. Figures show a gum elastic bougie; the Mallampati classification; appropriate oropharyngeal, laryngeal, and tracheal axes; advancing the laryngoscope to lift the epiglottis; endotracheal tube position in neonates; and synchronized intermittent mandatory ventilation pressure-regulated volume control mechanical ventilation. Tables list endotracheal tube sizes, neonatal endotracheal tube sizes, pediatric laryngeal mask airway sizes, commonly used induction agents, and endotracheal tube insertion depth guidelines. This review contains 6 figures, 8 tables, and 77 references. Key words: emergent tracheal intubation; endotracheal tube; laryngoscopy; pediatric airway; pediatric airway management; pediatric endotracheal intubation; pediatric laryngeal mask; video laryngoscopy

The effect of placement of a support under the shoulders on laryngeal visualization with a C-MAC Miller Video Laryngoscope in children younger than 2years of age.

We aimed to evaluate glottis visualization and time to intubation in children younger than 2years of age during laryngoscopy performed with a C-MAC Miller Video Laryngoscope in a position determined by placing a folded towel under the shoulders to align the oral-pharyngeal and laryngeal axes in the horizontal plane. Ninety-six children younger than 2years of age, who were classified by the American Society of Anesthesiologists as having a physical status I or II and who were scheduled for elective surgery necessitating endotracheal intubation under general anesthesia, were included in the study. All patients were intubated with a C-MAC Miller Video Laryngoscope. The children intubated by placing a folded towel under the shoulders were categorized as Group 1 (n=48), and the children intubated without placement of a folded towel were categorized as Group 2 (n=48). The percentage of glottis opening and Cormack-Lehane Scores, values of visual analogue scale to determine the ease of using a C-MAC Miller Video Laryngoscope, time to intubation, number of intubation attempts, optimization procedures and complications were recorded for all children. There was a statistically significant difference between Group 1 (mean±SD; 97.71±4.24) and Group 2 (mean±SD; 94.17±7.09) in terms of the percentage of glottis opening scores (P=0.004). The mean difference in the percentage of glottis opening scores (95% confidence interval) between the groups was 3.54 (1.17-5.90). We showed that a folded towel placed under the shoulders in children younger than 2years of age improves glottis visualization provides ease of use of the C-MAC Miller Video Laryngoscope. Therefore, we think that the placement of a folded towel under the shoulders during the use of a C-MAC Miller Video Laryngoscope may be useful for airway management in children younger than 2years of age.

Intubation with King Vision® video laryngoscope and Macintosh laryngoscope in cervical spine injured: A randomized controlled trial

Background: Intubation of trachea with conventional laryngoscopy requires alignment of the oropharyngeal–laryngeal axis in a straight line. This causes significant movement of the cervical spine, which in case of any previous injury to the spinal cord, may be further damaged due to impingement of the cord between the broken vertebrae. King Vision® video laryngoscope due to its particular J shape and a channel to carry the tube, causes less movement of the spine and hence provides better and safer intubation conditions in patients who have cervical injury. Methods: The study was conducted in a tertiary-level orthopedic and spine center. It was a single-blind randomized control study. After obtaining permission from Hospital Ethics Committee and patient's consent, 60 patients of cervical spine injury of American Society of Anesthesiologists I-III, and normal airway anatomy, were assessed for ease and safety of intubation by – (a) King Vision® video laryngoscope and (b) Macintosh laryngoscope. The primary criteria were Intubation Difficulty Scale (IDS), while the secondary criteria were duration of intubation, heart rate, and mean arterial pressure. Results: Results were analyzed by Chi-square, Mann–Whitney, and Student t-test using SPSS software. P value was 0.05. The mean IDS in King Vision® video laryngoscope group was significantly less than Macintosh group. However, there was no statistical difference in duration of intubation and hemodynamic parameters. Conclusions: Intubation in cervical spine injury patients with neck immobilization is easier with King Vision® video laryngoscope, but duration of intubation, complication rate, and hemodynamic parameters remain the same as compared with Macintosh laryngoscope.

Non-Convulsive Status Epilepticus (NCSE) in ICU

Background: This study aimed to get optimal sniffing position for successful intubation rate and measuring intubation time. The classical rationale for the sniffing position is that the alignment of the mandibular axis, pharyngeal axis, and laryngeal axis is facilitated, permitting successful direct laryngoscopy. Patients and Methods: A total of 100 patients without any anticipated difficult airway were enrolled after informed consent is given. After induction of anesthesia, patients were randomly divided into two groups. In Group PB, a deflated pressure infusion bag was put under the nape of the neck and occiput. The anesthetist performed laryngoscopy with the left hand while inflating the bag with the right hand up to the best glottic view without external pressure is achieved. The height of the bag was measured. In Group PI, 10-cm fixed-height noncompressible pillow was placed behind the head up to the shoulder. The best glottic view of the entire glottis without external pressure was noticed. Grading of glottic opening grade, SPO2, intubation time, and intubation trials were also noted. Results: Failure to intubate was noted in one patient in Group PB and two in Group PI. Intubations successful in 45 (90%) patients in Group PB as compared to 38 (76%) patients in Group PI (P

Comparison of success of tracheal intubation using Macintosh laryngoscope-assisted Bonfils fiberscope and Truview video laryngoscope in simulated difficult airway

Background and Aims:Restriction of head and neck movements prevents the alignment of the oral, pharyngeal, and laryngeal axes and increases the incidence of difficult tracheal intubation in patients with cervical spine fractures. Video laryngoscopes have gained an important role in the management of difficult intubation, especially in situations with limited head and neck movements. This study compares the success of intubation using Macintosh laryngoscope assisted Bonfils® fiberscope (ML-BF) with TruviewPCD video laryngoscope (TV) in patients with simulated restricted head and neck movements.Material and Methods:One hundred and fifty-two patients satisfying the inclusion criteria were randomly allocated to two groups of 76 each. Patients were made to lie supine on the table without a pillow and a soft collar was used to restrict head and neck movements. After a standardized premedication-induction sequence, tracheal intubation was done either with ML-BF or TV. Success of intubation, time taken for successful intubation, hemodynamic changes, airway trauma, and postoperative oropharyngeal morbidity were noted.Results:Intubation was successful in all the 76 patients in direct laryngoscopy-Bonfils fiberscope group and 75 out of 76 patients in TV group within the specified time (90 s). The median time taken for successful intubation with TV and ML-BF were 44 (range 26–80) s and 49 (range 28–83) s, respectively. Hemodynamic changes, airway trauma, and postoperative oropharyngeal morbidity were similar in both groups.Conclusion:Both TV and ML-BF are equally effective for successful tracheal intubation in patients with simulated restricted head and neck movements. In cases of difficult laryngeal visualization with routine Macintosh laryngoscope, Bonfils can be used as an adjunct to achieve successful intubation in the same laryngoscopy attempt.

Upper airway modifications in head extension during development

BackgroundOne of the requirements of laryngoscopy is to determine which head position will result in optimal visualization. Our hypothesis was that parameters derived from magnetic resonance imaging (MRI) can help quantify the effect of age on airway modifications due to head extension during development. MethodIn children undergoing planned MRI, additional sequences on the upper airways were performed: one in a near-neutral position, the other with the head extended at 35°. The axis of the face, the pharynx, the larynx, the trachea, and the line of glottic visualization were determined. The following angles were calculated: the Visu-Lar angle, formed by the line of glottic visualization and the laryngeal axis, and the Phar-Lar angle, formed by the pharyngeal and laryngeal axes. ResultsOne hundred and fifty-five patients (1 to 222 months of age [25–145] months) were included and 54% were under general anaesthesia. Age had no effect on the variation in the Visu-Lar angle, which diminished as a function of head extension, nor on the variation in the Phar-Lar angle, which was minimal in the neutral position. During extension, anatomical axes rotated similarly, and the visualization axis rotated the most, followed by the pharyngeal and laryngeal axes. These results were not correlated with general anaesthesia. ConclusionRegardless of age, head extension diminished the Visu-Lar angle, and increased the Phar-Lar angle. This study supports that, as in adults, head extension is probably the key factor for good visualization conditions during laryngoscopy on children, but clinical data is needed to confirm this result.

Comparison of Truview PCD and Trupti blade laryngoscope in adult patients of anticipated difficult Intubation

Background: The Truview PCD and Trupti blade provide better view of vocal cords and do not require the proper alignment of the oral, pharyngeal, and laryngeal axes as required with the Macintosh blade. Objective: To compare the laryngeal view and hemodynamic response to laryngoscopy and intubation with Truview PCD and Trupti blade in cases with single or multiple predictors of difficult intubation (PDI). Materials and Methods: Sixty adult patients of both sexes who were scheduled to undergo general anesthesia with endotracheal intubation were divided into two groups. Laryngoscopy was performed with Truview blade in group A and with Trupti blade in group B. Laryngeal view was graded by the Cormack–Lehane classification after laryngoscopy. Hemodynamic response during laryngoscopy and intubation was compared in both the groups. Results: Truview PCD was found to have better Cormack–Lehane glottic view and less hemodynamic response. The time required for the tracheal intubation was higher with Truview PCD blade than that with Trupti blade. Conclusion: The Truview PCD and Trupti blade both are better for intubation in adult patients having less than three PDI.

The New Maneuver for Difficult Intubation

It is believed that the airway management is more difficult in obese than nonobese patients due to the anatomic changes resulting from overweight. In this investigation was studied the new maneuver for difficult tracheal intubation in one obese patient. An 85 year old obese and diabetic man with cardiopulmonary arrest and without history of trauma was brought to the emergency department (ED). In this patient, the neck circumference was greater and sternomental distance was shorter than ordinary individuals. The cardiopulmonary resuscitation (CPR) was begun for patient immediately. In this patient, tracheal intubation with the conventional method was unsuccessful. Then, the new method (swan neck maneuver) for difficult intubation was attempted in patient successfully. In this maneuver, the upper part of the back of patient was elevated with bolsters so that the neck of patient was extended at ease and pharyngeal axis was perch along with laryngeal axis. Then, intubation was performed in this position simply. It looks that this new maneuver can perform easily for difficult intubations in obese patients without history of trauma.

Intubación nasotraqueal con laringoscopio óptico Airtraq® en 2 casos de braquiterapia oral

Nasotracheal intubation is usually the selected airway approach for oral and maxillofacial surgery to enable a free surgical field. It is an unusual intubation technique with a high success rate. However, it is not free from difficulties and complications in certain groups of patients, like those with oral, facial or cervical tumors.The Airtraq® laryngoscope (Prodol Meditec, Vizcaya, Spain) is an optical device that facilitates tracheal intubation through the indirect visualization of the vocal cords, avoiding the need to align the oral, pharyngeal and laryngeal axis. It has shown to be useful in various difficult airway (DA) scenarios. There is a version of the device to assist with the nasal intubation technique.Two oral brachytherapy treatment cases classified as DA are discussed; the nasotracheal intubation of the patient awake was successful using the Airtraq optical laryngoscope.

Nasotracheal intubation with Airtraq optical laryngoscope in two cases of oral brachytherapy

Nasotracheal intubation is usually the selected airway approach for oral and maxillofacial surgery to enable a free surgical field. It is an unusual intubation technique with a high success rate. However, it is not free from difficulties and complications in certain groups of patients, like those with oral, facial or cervical tumors.The Airtraq® laryngoscope (Prodol Meditec, Vizcaya, Spain) is an optical device that facilitates tracheal intubation through the indirect visualization of the vocal cords, avoiding the need to align the oral, pharyngeal and laryngeal axis. It has shown to be useful in various difficult airway (DA) scenarios. There is a version of the device to assist with the nasal intubation technique.Two oral brachytherapy treatment cases classified as DA are discussed; the nasotracheal intubation of the patient awake was successful using the Airtraq optical laryngoscope.

Comparison of video laryngoscopy with direct laryngoscopy in patients with good glottic visualization: an observational study of 348 emergency intubations

Video laryngoscopy (VL) is known to improve glottic visualization and the first-attempt success rate compared with direct laryngoscopy (DL) in emergency tracheal intubations (ETIs). Since VL does not align the oral, pharyngeal, and laryngeal axes of the upper airway, it sometimes leads to failed intubation despite good glottic visualization. We tested the hypothesis that VL has a lower firstattempt success rate of ETI than DL among patients with good glottic visualization.

Application of a new combined model including radiological indicators to predict difficult airway in patients undergoing surgery for cervical spondylosis

Background Airway management is crucial in clinical anesthesia. Many complications associated with airway management result from unexpected difficult airway, but predicting a difficult airway is a major challenge. We investigated the efficacy of a new combined model including radiological indicators to predict difficult airway in patients undergoing surgery for cervical spondylosis, a population with a high incidence of difficult airway. Methods We randomly enrolled 303 patients scheduled for elective surgery for cervical spondylosis at Peking University Third Hospital between August 2012 and March 2013. Preoperatively, patients were evaluated for difficult airway according to a clinical index and parameters on lateral cervical radiographs and magnetic resonance images. Difficult airway was defined as Cormack-Lehane grades III-IV. Logistic regression was used to identify a combined (clinical and radiological) model for difficult airway. A receiver operating characteristic (ROC) curve was used to describe the effectiveness of prediction. Results We identified three clinical predictive factors using the ROC curve: mouth opening, sternomental distance, and neck mobility. We created a clinical model using three factors: gender, age, and mouth opening, with odds ratios (OR) of 0.370, 1.034, and 0.358, respectively. Using the clinical and radiological parameters, we formulated a combined model with five risk factors: gender, mouth opening, atlanto-occipital gap, the angle from the second to sixth cervical vertebraes in the neutral position, and the angle difference of δ (the angle between the laryngeal axis and the epiglottic axis) from the neutral position to extension (OR: 0.107, 0.355, 0.846, 1.057, and 0.952, respectively). The sensitivity and specificity of the combined model were 80.0% and 65.7%, respectively, and the ROC curve confirmed that the combined model was better than any single clinical predictor and the clinical model. Conclusion The efficacy of the combined model including both clinical and radiological indicators was better than any single clinical predictor or the clinical model in patients undergoing elective surgery for cervical spondylosis.