title: Predicting difficult laryngoscopy in acromegalic patients undergoing surgery for excision of pituitary tumors: A comparison of extended Mallampati score with modified Mallampati classification.
abstract: BACKGROUND
  There are numerous reports of difficult laryngoscopy and intubation in patients with acromegaly. To date, no study has assessed the application of extended Mallampati score (EMS) for predicting difficult intubation in acromegalics. The primary aim of this study was to compare EMS with modified Mallampati classification (MMP) in predicting difficult laryngoscopy in acromegalic patients. We hypothesized that since EMS has been reported to be more specific and better predictor than MMP, it may be superior to the MMP to predict difficult laryngoscopy in acromegalic patients.
  
  
  METHODS
  For this prospective cohort study with matched controls, acromegalic patients scheduled to undergo pituitary surgery over a period of 3 years (January 2008-December 2010) were enrolled. Preoperative airway assessment was performed by experienced anesthesiologists and involved a MMP and the EMS. Under anesthesia, laryngoscopic view was assessed using Cormack-Lehane (CL) grading. MMP and CL grades of I and II were defined "easy" and III and IV as "difficult". EMS grade of I and II were defined "easy" and III as "difficult". Data were used to determine the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MMP and EMS in predicting difficult laryngoscopy.
  
  
  RESULTS
  Seventy eight patients participated in the study (39 patients in each group). Both MMP and EMS failed to detect difficult laryngoscopy in seven patients. Only one laryngoscopy was predicted to be difficult by both tests which was in fact, difficult.
  
  
  CONCLUSIONS
  We found that addition of neck extension did not improve the predictive value of MMP.
authors.affiliation: Department of Neuroanaesthesiology, Neurosciences Center, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Ashish
authors.initials: A
authors.lastname: Bindra
authors.forename: Hemanshu
authors.initials: H
authors.lastname: Prabhakar
authors.forename: Parmod K
authors.initials: PK
authors.lastname: Bithal
authors.forename: Gyaninder Pal
authors.initials: GP
authors.lastname: Singh
authors.forename: Tumul
authors.initials: T
authors.lastname: Chowdhury
keywords: Acromegaly; Mallampati classification; airway; extended Mallampati score