Predicting difficulty Tracheal intubation

tracheal intubation anticipated difficult in child massive ameloblastoma

tracheal intubation not simple procedure , consequences of failure grave. therefore, patient evaluated potential difficulty or complications beforehand. involves taking medical history of patient , performing physical examination, results of can scored against 1 of several classification systems. proposed surgical procedure (e.g., surgery involving head , neck, or bariatric surgery) may lead 1 anticipate difficulties intubation. many individuals have unusual airway anatomy, such have limited movement of neck or jaw, or have tumors, deep swelling due injury or allergy, developmental abnormalities of jaw, or excess fatty tissue of face , neck. using conventional laryngoscopic techniques, intubation of trachea can difficult or impossible in such patients. why persons performing tracheal intubation must familiar alternative techniques of securing airway. use of flexible fiberoptic bronchoscope , similar devices has become among preferred techniques in management of such cases. however, these devices require different skill set employed conventional laryngoscopy , expensive purchase, maintain , repair.

when taking patient s medical history, subject questioned significant signs or symptoms, such difficulty in speaking or difficulty in breathing. these may suggest obstructing lesions in various locations within upper airway, larynx, or tracheobronchial tree. history of previous surgery (e.g., previous cervical fusion), injury, radiation therapy, or tumors involving head, neck , upper chest can provide clues potentially difficult intubation. previous experiences tracheal intubation, difficult intubation, intubation prolonged duration (e.g., intensive care unit) or prior tracheotomy noted.

a detailed physical examination of airway important, particularly:

the range of motion of cervical spine: subject should able tilt head , forward chin touches chest.
the range of motion of jaw (the temporomandibular joint): 3 of subject s fingers should able fit between upper , lower incisors.
the size , shape of upper jaw , lower jaw, looking problems such maxillary hypoplasia (an underdeveloped upper jaw), micrognathia (an abnormally small jaw), or retrognathia (misalignment of upper , lower jaw).
the thyromental distance: 3 of subject s fingers should able fit between adam s apple , chin.
the size , shape of tongue , palate relative size of mouth.
the teeth, noting presence of prominent maxillary incisors, loose or damaged teeth, or crowns.

many classification systems have been developed in effort predict difficulty of tracheal intubation, including cormack-lehane classification system, intubation difficulty scale (ids), , mallampati score. mallampati score drawn observation size of base of tongue influences difficulty of intubation. determined looking @ anatomy of mouth, , in particular visibility of base of palatine uvula, faucial pillars , soft palate. although such medical scoring systems may aid in evaluation of patients, no single score or combination of scores can trusted detect , patients difficult intubate. furthermore, 1 study of experienced anesthesiologists, on used cormack–lehane classification system, found did not score same patients consistently on time, , 25% correctly define 4 grades of used cormack–lehane classification system. under emergency circumstances (e.g., severe head trauma or suspected cervical spine injury), may impossible utilize these physical examination , various classification systems predict difficulty of tracheal intubation. in such cases, alternative techniques of securing airway must readily available.