Upper Lip Bite Test for Prediction of Difficult Airway: A Systematic Review

Overview

Journal Pak J Med Sci

Specialty General Medicine

Date 2018 Sep 8

PMID 30190773

Citations 13

Authors

Elnaz Faramarzi

Hassan Soleimanpour

Zahid Hussain Khan

Ata Mahmoodpoor

Sarvin Sanaie

Affiliations

Soon will be listed here.

Abstract

Background And Objective: Upper lip bite test (ULBT) is one of the various bedside tests used for prediction of difficult laryngoscopic intubation. However, its usefulness is not still very clear, and there is controversy regarding its accuracy. The aim of this systematic review was to determine the accuracy of the ULBT for predicting difficult airway including difficult laryngoscopy or difficult tracheal intubation.

Method: We searched the databases of PubMed, Scopus, and Google scholar for prospective studies published up until October 2016 assessing the accuracy of ULBT in comparison to Cormack-Lehane grading. The selected keywords were "upper lip bite test", "upper lip catch test", "prediction", "difficult airway", "difficult laryngoscopy", "difficult intubation". Inclusion criteria were studies assessing ULBT for prediction of difficult intubation, considering Cormack-Lehane grade III and IV as difficult airway, written in English, and reporting sensitivity, specificity, NPV, PPV, and accuracy. Exclusion criteria were studies not reporting accuracy or not having enough data for its calculation. Based on the mentioned criteria, 27 studies enrolling 18141 patients were included. This systematic review was performed based on the guidelines on conducting systematic reviews of diagnostic studies.

Results: Prevalence of airway difficulties according to the direct laryngoscopic view varied from 2.8% to 27% and according to the ULBT was from 2% to 21%. In 11 of the 27 studies, sensitivity of ULBT in prediction of difficult airway was more than 70%. All of the studies except one showed a high specificity for ULBT (>85%). Moreover, these studies indicated a high NPV. Accuracy of ULBT was >85% in 24 out of 27 studies.

Conclusion: It appears that ULBT is a useful bedside test for evaluation of patient airway before the general anesthesia.

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References

Shah P, Dubey K, Yadav J . Predictive value of upper lip bite test and ratio of height to thyromental distance compared to other multivariate airway assessment tests for difficult laryngoscopy in apparently normal patients. J Anaesthesiol Clin Pharmacol. 2013; 29(2):191-5. PMC: 3713666. DOI: 10.4103/0970-9185.111700. View

Cormack R, Lehane J . Difficult tracheal intubation in obstetrics. Anaesthesia. 1984; 39(11):1105-11. View

Savva D . Prediction of difficult tracheal intubation. Br J Anaesth. 1994; 73(2):149-53. DOI: 10.1093/bja/73.2.149. View

Khan Z, Maleki A, Makarem J, Mohammadi M, Khan R, Zandieh A . A comparison of the upper lip bite test with hyomental/thyrosternal distances and mandible length in predicting difficulty in intubation: A prospective study. Indian J Anaesth. 2011; 55(1):43-6. PMC: 3057244. DOI: 10.4103/0019-5049.76603. View

Hester C, Dietrich S, White S, Secrest J, Lindgren K, Smith T . A comparison of preoperative airway assessment techniques: the modified Mallampati and the upper lip bite test. AANA J. 2007; 75(3):177-82. View

Khan Z, Mohammadi M, Rasouli M, Farrokhnia F, Khan R . 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; 109(3):822-4. DOI: 10.1213/ane.0b013e3181af7f0d. View

Wajekar A, Chellam S, Toal P . Prediction of ease of laryngoscopy and intubation-role of upper lip bite test, modified mallampati classification, and thyromental distance in various combination. J Family Med Prim Care. 2015; 4(1):101-5. PMC: 4366978. DOI: 10.4103/2249-4863.152264. View

Min J, Kim G, Kim E, Lee J . The diagnostic validity of clinical airway assessments for predicting difficult laryngoscopy using a grey zone approach. J Int Med Res. 2016; 44(4):893-904. PMC: 5536638. DOI: 10.1177/0300060516642647. View

Mehta T, Jayaprakash J, Shah V . Diagnostic value of different screening tests in isolation or combination for predicting difficult intubation: A prospective study. Indian J Anaesth. 2015; 58(6):754-7. PMC: 4296366. DOI: 10.4103/0019-5049.147176. View

10.

Mallampati S, Gatt S, Gugino L, Desai S, Waraksa B, Freiberger D . A clinical sign to predict difficult tracheal intubation: a prospective study. Can Anaesth Soc J. 1985; 32(4):429-34. DOI: 10.1007/BF03011357. View

11.

Honarmand A, Safavi M, Yaraghi A, Attari M, Khazaei M, Zamani M . Comparison of five methods in predicting difficult laryngoscopy: Neck circumference, neck circumference to thyromental distance ratio, the ratio of height to thyromental distance, upper lip bite test and Mallampati test. Adv Biomed Res. 2015; 4:122. PMC: 4513312. DOI: 10.4103/2277-9175.158033. View

12.

Khan Z, 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(2):595-9, table of contents. DOI: 10.1097/00000539-200302000-00053. View

13.

Deville W, Buntinx F, Bouter L, Montori V, de Vet H, van der Windt D . Conducting systematic reviews of diagnostic studies: didactic guidelines. BMC Med Res Methodol. 2002; 2:9. PMC: 117243. DOI: 10.1186/1471-2288-2-9. View

14.

Myneni N, OLeary A, Sandison M, Roberts K . Evaluation of the upper lip bite test in predicting difficult laryngoscopy. J Clin Anesth. 2010; 22(3):174-8. DOI: 10.1016/j.jclinane.2009.06.004. View

15.

Randell T . Prediction of difficult intubation. Acta Anaesthesiol Scand. 1996; 40(8 Pt 2):1016-23. DOI: 10.1111/j.1399-6576.1996.tb05620.x. View

16.

Al Ramadhani S, Mohamed L, Rocke D, Gouws E, Ramadhani S . Sternomental distance as the sole predictor of difficult laryngoscopy in obstetric anaesthesia. Br J Anaesth. 1996; 77(3):312-6. DOI: 10.1093/bja/77.3.312. View

17.

Sharma D, Prabhakar H, Bithal P, Ali Z, Singh G, Rath G . Predicting difficult laryngoscopy in acromegaly: a comparison of upper lip bite test with modified Mallampati classification. J Neurosurg Anesthesiol. 2010; 22(2):138-43. DOI: 10.1097/ANA.0b013e3181ce6a60. View

18.

Khan Z, Arbabi S . Diagnostic value of the upper lip bite test in predicting difficulty in intubation with head and neck landmarks obtained from lateral neck X-ray. Indian J Anaesth. 2013; 57(4):381-6. PMC: 3800331. DOI: 10.4103/0019-5049.118567. View

19.

Salimi A, Farzanegan B, Rastegarpour A, Kolahi A . Comparison of the upper lip bite test with measurement of thyromental distance for prediction of difficult intubations. Acta Anaesthesiol Taiwan. 2008; 46(2):61-5. DOI: 10.1016/S1875-4597(08)60027-2. View

20.

Ali M, Qamar-Ul-Hoda M, Samad K . Comparison of upper lip bite test with Mallampati test in the prediction of difficult intubation at a tertiary care hospital of Pakistan. J Pak Med Assoc. 2013; 62(10):1012-5. View