title: Diagnostic value of the upper lip bite test in predicting difficulty in intubation with head and neck landmarks obtained from lateral neck X-ray.
abstract: BACKGROUND
  Unanticipated difficult tracheal intubation remains a primary concern of anaesthesiologists and upper lip bite test (ULBT) is one of the assessments used in predicting difficult intubation. In this study, we aimed to check the utility of lateral neck X-ray measurements in improving the diagnostic value of the ULBT.
  
  
  METHODS
  In a prospective study conducted from January 2007 until December 2010, we recorded personal and demographic data of 4500 patients who entered the study and subjected them to standard lateral neck radiography. Before the induction of anaesthesia, clinical examination and ULBT results were recorded and during induction of anaesthesia laryngoscopic grading was evaluated and recorded in questionnaires. All the compiled data were analysed by SPSS 14.0 (SPSS Inc., Chicago, IL, USA) software. Diagnostic value for each test was calculated and compared.
  
  
  RESULTS
  Negative predictive values (NPVs) were high in all tests. ULBT had the highest specificity and NPV compared with the other tests. The positive predictive value for all the tests had been low, but marginally high in the ULBT.
  
  
  CONCLUSIONS
  Although all the tests used had relatively acceptable predictive values, combination of tests appeared to be more predictive. Highest sensitivities were observed with ULBT, mandibulohyoid distance and thyromental distance respectively. Use of radiological parameters may not be suitable as screening tools, but may help in anticipating and preparing for a difficult scenario.
authors.affiliation: Department of Anesthesiology and Intensive Care, Imam Khomeini Medical Center, Keshavarz Blvd., Tehran, Iran.
authors.forename: Zahid Hussain
authors.initials: ZH
authors.lastname: Khan
authors.forename: Shahriar
authors.initials: S
authors.lastname: Arbabi
keywords: Airway assessment; difficult intubation; lateral neck radiography; predictive tests; upper lip bite test