• Tino Münster, Melanie Hoffmann, Sven Schlaffer, Harald Ihmsen, Hubert Schmitt, and Alexander Tzabazis.
• From the Department of Anaesthesiology (TM, HS, MH, HI); Department of Neurosurgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (SS); and Department of Anaesthesiology, Perioperative and Pain Medicine, School of Medicine, Stanford University, Stanford, California, USA (AT).
• Eur J Anaesthesiol. 2016 Apr 1; 33 (4): 257-62.

BackgroundSeveral anatomical factors, such as prognathism, sex, short thyromental distance and others are known to make direct laryngoscopy difficult.ObjectiveWe investigated the hypothesis that the anatomical position of the vocal cords in relation to the cervical vertebrae correlates with difficult laryngoscopy. Existing MRI was used to identify the position of the vocal cords relative to the cervical spine in patients with and without difficult laryngoscopy.DesignObservational study with adaptive enrichment.SettingUniversity hospital.PatientsA total of 142 adult patients, 91 with easy (Cormack-Lehane class 1 or 2) and 51 with difficult (Cormack-Lehane class 3 or 4) laryngoscopy.Main Outcome MeasuresPosition of the vocal cords relative to cervical vertebrae in patients with easy vs. difficult laryngoscopy.ResultsIn patients with difficult laryngoscopy, we found a higher incidence of cranial position of the vocal cords in relation to the cervical spine compared with patients with easy laryngoscopy (P < 0.001).ConclusionAnaesthesiologists should take advantage of existing imaging of the cervical spine when assessing the patient's airway.

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