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LETTER TO THE EDITOR

The Upper Lip Bite Test to Predict Difficult Intubation

Academic Department of Military Anaesthesia; Royal Centre for Defence Medicine; Birmingham UK; j.l.tong{at}bham.ac.uk (Tong) Department of Anaesthesia; Birmingham Heartlands Hospital; Birmingham UK (Gait)

To the Editor:

In a recent report, the upper lip bite test was used to correctly predict an easy intubation in a patient with Cushing's and Nelson's syndromes.1

Their article describes the oropharyngeal image in Figure 2 as a Class IV airway, using the Samsoon and Young modification of Mallampati classification. The published image is incorrect, as the lower lip is still visible because the tongue has not been maximally protruded.2 Bedside airway screening tests must be reliable and quick to perform. The use of single screening tests for difficult intubation3 is associated with low Positive Predictive Value (the proportion of cases predicted to be difficult, who actually were difficult), but it is crucial that whichever assessment is used, it must be performed correctly.

Finally, forward movement of the mandible according to the position of the lower incisors in relation to the upper incisors, has previously been published in this Journal.4,5

REFERENCES

1. Khan ZH, Gharabaghian M, Ferozeh N, Ghiamat M, Mohammadi M. Easy endotracheal intubation of a patient suffering from both Cushing's and Nelson's Syndromes predicted by the upper lip bite test despite a Mallampati class 4 airway. Anesth Analg 2007;105:786–7[Abstract/Free Full Text]
2. Samsoon GLT, Young JRB. Difficult tracheal intubation: a retrospective study. Anaesthesia 1987;42:487–90[Web of Science][Medline]
3. Eberhart LH, Arndt C, Cierpka T, Schwanekamp J, Wulf H, Putzke C. The reliability and validity of the upper lip bite test compared with the Mallampati classification to predict difficult laryngoscopy: an external prospective evaluation. Anesth Analg 2005;101:284–9[Abstract/Free Full Text]
4. Brechner VL. Unusual problems in tracheal intubation – 1. Anesth Analg 1968; 47:362–73[Free Full Text]
5. Block C, Brechner VL. Unusual problems in airway management – 2. Anesth Analg 1971;50:114–23[Free Full Text]
6. Khan ZH, Kashfi A, Ebrahimkhani E. A comparison of the upper lip bite test (a simple new technique) with modified Mallampati classification in predicting difficulty in endotracheal intubation: a prospective blinded study. Anesth Analg 2003;96:595–9[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Web of Science (1) Citing Articles via Google Scholar Google Scholar Articles by Tong, J. L. Articles by Gait, A. J. Search for Related Content PubMed PubMed Citation Articles by Tong, J. L. Articles by Gait, A. J.