Components of the preoperative airway physical examination

Airway examination component	Nonreassuring findings
Length of upper incisors	Relatively long
Relationship of maxillary and mandibular incisors during normal jaw closure	Prominent "overbite" (maxillary incisors anterior to mandibular incisors)
Relationship of maxillary and mandibular incisors during voluntary protrusion of mandible*	Patient cannot bring mandibular incisors anterior to (in front of) maxillary incisors
Interincisor distance	Less than 3 cm
Visibility of uvula	Not visible when tongue is protruded with patient in sitting position (eg, Mallampati class >2)
Shape of palate	Highly arched or very narrow
Compliance of mandibular space	Stiff, indurated, occupied by mass, or non-resilient
Thyromental distance	Less than three ordinary finger-breadths
Length of neck	Short
Thickness of neck	Thick
Range of motion of head and neck	Patient cannot touch tip of chin to chest or cannot extend neck

This table displays some findings of the airway physical examination that may suggest the presence of a difficult intubation. The decision to examine some or all of the airway components shown on this table depends on the clinical context and judgment of the practitioner. The table is not intended as a mandatory or exhaustive list of the components of an airway examination. The order of presentation in this table follows the "line of sight" that occurs during conventional oral laryngoscopy.

* A more objective measurement related too mandibular protrusion is the upper lip bite test, which assesses the patient's ability to reach and cover the upper lip with their lower incisors. Grading for the upper lip bite test is as follows:

Grade 1: The patient can fully cover the upper lip with lower incisors
Grade 2: The patient can partially cover the upper lip with lower incisors
Grade 3: The patient cannot reach the upper lip with lower teeth

From: Apfelbaum JL, Hagberg CA, Caplan RA, et al. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology 2013; 118:251. DOI: 10.1097/ALN.0b013e31827773b2. Copyright © 2013 American Society of Anesthesiologists. Reproduced with permission from Wolters Kluwer Health. Unauthorized reproduction of this material is prohibited.

Graphic 108981 Version 11.0

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Components of the preoperative airway physical examination