The diagnostic value of the upper lip bite test combined with sternomental distance, thyromental distance, and interincisor distance for prediction of easy laryngoscopy and intubation: a prospective study

Anesth Analg. 2009 Sep;109(3):822-4. doi: 10.1213/ane.0b013e3181af7f0d.


Background: Accuracy of upper lip bite test (ULBT) has been compared with the Mallampati classification. In this study, we investigated whether the combination of the ULBT classification with sternomental distance (SMD), thyromental distance (TMD), and interincisor distance (IID) or a composite score can improve the ability to predict easy laryngoscopy and intubation compared with each test alone.

Methods: In a prospective study, 380 patients who were scheduled for elective surgery were selected randomly and enrolled in the study. Before inducing anesthesia, the airways were assessed, and ULBT class, SMD, TMD, and IID determined. Laryngoscopic view according to the Cormack and Lehane grading system was determined after induction of anesthesia and Grades 3 and 4 defined as "difficult intubation." By using receiver operating characteristic analysis, the best cutoff points of the tests were calculated. Finally, sensitivity, specificity, positive and negative predictive values and accuracy of these tests and their combinations with the ULBT were calculated.

Results: The prevalence of difficult intubation was 5% (n = 19). Class III ULBT, IID <4.5 cm, TMD <6.5 cm, and SMD <13 cm were defined as predictors of difficult intubation. There was no significant difference regarding difficult intubation based on gender (P < 0.05), whereas there were significant differences between the older tests and laryngeal view (P < 0.05, Mc-Nemar test). Specificity and accuracy of the ULBT were significantly higher than TMD, SMD, and IID individually (specificity was 91.69%, 82.27%, 70.64%, and 82.27%, respectively, and accuracy was 91.05%, 71.32%, 81.84%, and 76.58%, respectively). The combination of the ULBT with SMD provided the highest sensitivity.

Conclusion: We conclude that the specificity and accuracy of the ULBT is significantly higher than the other tests and is more accurate in airway assessment. However, the ULBT in conjunction with the other tests could more reliably predict easy laryngoscopy or intubation.

MeSH terms

  • Adult
  • Female
  • Humans
  • Intubation, Intratracheal / methods*
  • Jaw Relation Record
  • Laryngoscopy / methods*
  • Lip / pathology*
  • Male
  • Middle Aged
  • Prospective Studies
  • ROC Curve
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Thyroid Cartilage / pathology