• Adrianna M Hekiert, Rosemarie Mick, and Natasha Mirza.
• Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Medical Center, 3400 Spruce St, 5th Floor Ravdin Bldg, Philadelphia, PA 19104, USA.
• Ann Oto Rhinol Laryn. 2007 Nov 1;116(11):799-804.

ObjectivesThis study was intended to 1) identify preoperative predictors of difficult laryngoscopy and 2) determine the role of obesity in difficulty of obtaining adequate laryngeal exposure.MethodsA prospective study was undertaken of 63 patients who were undergoing elective direct laryngoscopy. Thirty-six patients met the obesity criteria (body mass index of at least 30 kg/m2). Measurements of height, weight, and neck circumference and Mallampati and Cormack-Lehane scores were obtained. The ease of laryngeal exposure was recorded by the attending surgeon on a visual analog scale (VAS; 1 to 10). Difficult laryngeal exposure (DLE) was defined as a VAS score of at least 3. The candidate morphological predictors were investigated.ResultsObesity and Mallampati score were found to be predictors of DLE (p < .001). The VAS score was positively correlated with body mass index (p = .007), weight (p = .05), Mallampati score (p < .001), and Cormack-Lehane score (p < .001). Among obese patients, the VAS score was correlated with the Cormack-Lehane score (p = .01), whereas in nonobese patients the VAS score showed a significant association with both the Mallampati (p = .02) and Cormack-Lehane (p = .01) scores.ConclusionsObese patients and those with a Mallampati score of at least 2 posed a significantly higher risk of DLE. Preoperative identification of a potentially difficult airway may aid surgical planning and allow more effective communication with a collaborating anesthesiologist.

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