title: A comparison of between hyomental distance ratios, ratio of height to thyromental, modified Mallamapati classification test and upper lip bite test in predicting difficult laryngoscopy of patients undergoing general anesthesia.
abstract: BACKGROUND
  Failed intubation is imperative source of anesthetic interrelated patient's mortality. The aim of this present study was to compare the ability to predict difficult visualization of the larynx from the following pre-operative airway predictive indices, in isolation and combination: Modified Mallampati test (MMT), the ratio of height to thyromental distance (RHTMD), hyomental distance ratios (HMDR), and the upper-lip-bite test (ULBT).
  
  
  METHODS
  We collected data on 525 consecutive patients scheduled for elective surgery under general anesthesia requiring endotracheal intubation and then evaluated all four factors before surgery. A skilled anesthesiologist, not imparted of the noted pre-operative airway assessment, did the laryngoscopy and rating (as per Cormack and Lehane's classification). Sensitivity, specificity, and positive predictive value for every airway predictor in isolation and in combination were established.
  
  
  RESULTS
  The most sensitive of the single tests was ULBT with a sensitivity of 90.2%. The hyomental distance extreme of head extension was the least sensitive of the single tests with a sensitivity of 56.9. The HMDR had sensitivity 86.3%. The ULBT had the highest negative predictive value: And the area under a receiver-operating characteristic curve (AUC of ROC curve) among single predictors. The AUC of ROC curve for ULBT, HMDR and RHTMD was significantly more than for MMT (P < 0.05). No significant difference was noted in the AUC of ROC curve for ULBT, HMDR, and RHTMD (P > 0.05).
  
  
  CONCLUSIONS
  The HMDR is comparable with RHTMD and ULBT for prediction of difficult laryngoscopy in the general population, but was significantly more than for MMT.
authors.affiliation: Departments of Anesthesia, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Azim
authors.initials: A
authors.lastname: Honarmand
authors.affiliation: Departments of Anesthesia, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Mohammadreza
authors.initials: M
authors.lastname: Safavi
authors.affiliation: Departments of Anesthesia, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Narges
authors.initials: N
authors.lastname: Ansari
keywords: Failed intubation; hyomental distance ratios; laryngoscopy; modified Mallampati test; ratio of height to thyromental distance; upper-lip-bite test