title: Increased body mass index per se is not a predictor of difficult laryngoscopy.
abstract: OBJECTIVE
  We investigated the association between morbid obesity and difficult laryngoscopy (DL).
  
  
  METHODS
  In a prospective, controlled study we evaluated the impact of different variables on the prediction of DL in 200 morbidly obese (study group-SG), and 1272 non-obese (control group-CG) patients undergoing elective surgery. Variables assessed included age, sex, body mass index (BMI), protruding, loose, and missing upper teeth, thyro-mental distance, temporo-mandibular joint (TMJ) function, neck extension, and Mallampati class. A Cormack grade III or IV was considered DL.
  
  
  RESULTS
  The SG patients were younger (P < 0.000), there were more females in the SG (P < 0.000) and more in the SG had teeth problems (P = 0.026). More patients in the SG (10% vs 1%), had obstructive sleep apnea (P < 0.001) with 90% of them in the SG having a grade III laryngoscopy. High BMI did not affect the laryngoscopy difficulty (P = 0.56). Multivariable regression analysis revealed that morbid obesity, increased age, male sex, pathology of TMJ, and higher Mallampati class, were independent predictors of DL. When interaction between the predictors and the group was added to the multivariable model, the SG was no longer a predictor by itself, rather its association with abnormal upper teeth turned to be significant for prediction of DL.
  
  
  CONCLUSIONS
  Increased age, male sex, TMJ pathology, Mallampati 3 and 4, a history of obstructive sleep apnea and abnormal upper teeth were associated with a higher incidence of DL. The magnitude of BMI had no influence on difficulty with laryngoscopy.
authors.affiliation: Departments of Anesthesia, Wolfson Medical Center, Holon, Affiliated with Sackler School of Medicine, Tel Aviv, Israel. tezri@netvision.net.il
authors.forename: Tiberiu
authors.initials: T
authors.lastname: Ezri
authors.forename: Beniamin
authors.initials: B
authors.lastname: Medalion
authors.forename: Marian
authors.initials: M
authors.lastname: Weisenberg
authors.forename: Peter
authors.initials: P
authors.lastname: Szmuk
authors.forename: R David
authors.initials: RD
authors.lastname: Warters
authors.forename: Ilan
authors.initials: I
authors.lastname: Charuzi
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D005260:Female; D006801:Humans; D007828:Laryngoscopy; D007830:Larynx / Q000033:anatomy & histology; D008297:Male; D008875:Middle Aged; D009055:Mouth / Q000033:anatomy & histology; D009333:Neck / Q000033:anatomy & histology / Q000502:physiology; D009767:Obesity, Morbid / Q000150:complications; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020181:Sleep Apnea, Obstructive / Q000150:complications; D013704:Temporomandibular Joint / Q000502:physiology; D014070:Tooth / Q000502:physiology