Skip to main content Accessibility help

Lateral neck radiography for prediction of difficult orotracheal intubation

  • H. Kamalipour (a1), M. Bagheri (a2), K. Kamali (a2), A. Taleie (a1) and H. Yarmohammadi (a3)...



Background and objectives: Failed endotracheal intubation is a principal cause of morbidity and mortality in anesthetized patients. The aim of this study was to investigate the efficiency of lateral neck radiography in predicting difficult intubation. Methods: In a prospective triple-blind study, 100 patients (aged 18–89 yr), scheduled for elective surgery were randomly selected. Lateral neck X-ray was obtained from each of the patients before operation. Several angles and parameters on the X-ray were proposed to illustrate a relationship with easy or difficult intubation. A radiologist recorded these angles before the operation. An anaesthesiologist also determined the Mallampati score preoperation. At the time of intubation, two other anesthesiologists performed a laryngoscopy and, according to established criteria, identified the patients as easy or difficult intubation. The results were then compared with each other. Results: Fifteen patients were identified as having difficult intubation (laryngoscopy Grades III and IV). Sensitivity and specificity of the Mallampati Class test were 26% and 100%, respectively. The sensitivity and specificity of the lateral neck X-ray for three measured angles were 100%. The positive and negative predictive values (NPVs) for those angles were 100% and for Mallampati classification were 100% and 80%, respectively. Conclusions: Compared to the Mallampati Class test, our method of analyzing the lateral X-ray, although not as easy and universally applicable as Mallampati Class test, proved to be a suitable method for predicting difficult intubation.


Corresponding author

Correspondence to: Hamid Kamalipour, Department of Anesthesiology, Faghihi Hospital, Shiraz, P.O. Box 71345-3168, Iran. E-mail:; Tel: +98 911 7111112; Fax: +98 711 2307072


Hide All


Jimson CT, Eric BR, Ayyaz H. Predicting difficult endotracheal intubation in surgical patients scheduled for general anesthesia: a prospective blind study. Anes Analg 1995; 81: 254258.
Cormack RS, Lehnane J. Difficult tracheal intubation in obstetrics. Anesthesia 1984; 39: 11051111.
Caplan RA, Posner KL, Ward RJ et al. Adverse respiratory events in anesthesia: a closed claims analysis. Anesthesiology 1990; 72: 828833.
Wilson ME, Spiegelhalter D, Robertson JA, Lesser P. Predicting difficult intubation. Br J Anaesth 1988; 61: 211216.
Charter P, Perera S, Horton WA. Visibility of pharyngeal structures as a predictor of difficult intubation. Anaesthesia 1987; 42: 1115.
Oates JDL, Macleod AD, Oates PD et al. Comparison of two methods for predicting difficult intubation. Br J Anaesth 1991; 66: 305309.
Frerk CM. Predicting difficult intubation. Anaesthesia 1991; 46: 10051008.
Savva D. Prediction of difficult intubation. Br J Anaesth 1994; 73: 149153.
Samra SK, Schork MA, Guinto Jr FC. A study of radiologic imaging techniques and airway grading to predict a difficult endotracheal intubation. J Clin Anesth 1995; 7: 373379.
Naguib M, Malabarey T, AlSatli RA, Al Damegh S, Samarkandi AH. Predictive models for difficult laryngoscopy and intubation. A clinical, radiologic and three-dimensional computer imaging study. Can J Anaesth 1999; 46: 748759.
Mallampati SR, Gatt SP, Gugino LD et al. A clinical sign to predict difficult tracheal intubation: a prospective study. Can Anaesth Soc J 1985; 32: 429434.
Sutton D. The pharynx and larynx. In: Sutton D, ed. Textbook of Radiology and Imaging, 6th edn. New York, USA: Churchill Livingstone Inc, 1998: 12731276.
Bontrager K. Radiology anatomy and positioning of the chest. In: Bontrager KL, ed. Textbook of Radiographic Positioning and Related Anatomy, 3rd edn. New York, USA: Mosby Year Book, 1993: 5253.
Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 1982; 143: 2936.
Rocke DA, Murray WB, Rout CC et al. Relative risk analysis of factors associated with difficult intubation in obstetric anaesthesia. Anesthesiology 1992; 77: 6773.
Samsoon GTL, Young JRB. Difficult intubation: a retrospective study. Anesthesia 1987; 42: 487490.
Curry T, Dowdey J, Murry R. Protection. In: Christensen's Physics of Diagnostic Radiology, 4th edn. Philadelphia, USA: Lea and Febiger, 1990: 375377.
Hung OR, Morris I. Dynamic anatomy of upper airway: an essential paradigm. Can J Anaesth 2000; 47: 295298.


Related content

Powered by UNSILO

Lateral neck radiography for prediction of difficult orotracheal intubation

  • H. Kamalipour (a1), M. Bagheri (a2), K. Kamali (a2), A. Taleie (a1) and H. Yarmohammadi (a3)...


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.