title: Prediction of difficult laryngoscopy: Extended mallampati score versus the MMT, ULBT and RHTMD.
abstract: BACKGROUND
  Preoperative using of anatomical landmarks detects potentially difficult laryngoscopies. The main object of the present study was to evaluate the predictive power of Extended Mallampati Score (EMS) in comparison with modified Mallampati test (MMT), the ratio of height to thyromental distance (RHTMD) and the Upper-Lip-Bite test (ULBT) in isolation and combination.
  
  
  METHODS
  Four hundred seventy sixadult patients who candidate for elective surgery under general anesthesia requiring endotracheal intubation were included in this study and evaluated based of all four factors before surgery. This study was randomized prospective double - blind. After that, laryngoscopy was performed by an anesthesiologist who didn't involve in preoperative airway assessment and graded based on Cormack and Lehane's classification. We calculated sensitivity, specificity, and area under receiver-operating characteristic (ROC) (AUC) for each score.
  
  
  RESULTS
  The AUCof the ROC was significantly more for the ULBT (AUC = 0.820, P = 0.049) and RHTMD score (AUC = 0.845, P = 0.033) than the EMS (AUC = 0.703). This variable was significantly higher for the EMS compared with MMT (0.703 vs. 0.569, P = 0.046 respectively). There was no significant difference between the AUC of the ROC for the ULBT and the RHTMD score (P = 0.685). The optimalcut-off point for the RHTMD for predicting difficult laryngoscopy was 29.3.
  
  
  CONCLUSIONS
  EMS predicted difficult laryngoscopy better than MMT while both ULBT and RHTMD had more power than EMS and MMT in this regard. ULBT and RHTMD had similar predictive value for prediction of difficult laryngoscopy in general population.
authors.affiliation: Department of Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Mohammadreza
authors.initials: M
authors.lastname: Safavi
authors.affiliation: Department of Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Azim
authors.initials: A
authors.lastname: Honarmand
authors.affiliation: Department of Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Mahsa
authors.initials: M
authors.lastname: Amoushahi
keywords: Difficult laryngoscopy; extended mallampati score; modified mallampati; ratio of patient's height to thyromental distance; upper lip bite test