Submandible angle in nonobese patients with difficult tracheal intubation

Although functional immobility of craniofacial structures during direct laryngoscopy may cause difficult tracheal intubation (DTI), there may be an unfavorable specific craniofacial feature for successful tracheal intubation. The aim of this study was to identify the specific craniofacial features associated with DTI.

Digital photographs of nonobese patients with DTI (23 males and 18 females) and age- and body mass index-matched patients with easy tracheal intubation (ETI) (16 males and 16 females) were taken and used for measurements of various craniofacial dimensions. Composite facial pictures of each patient group were constructed for visualization of differences of the craniofacial features.

Mandible position angle was significantly smaller in DTI males than in male patients with ETI. Submandible angle was significantly larger in both male and female DTI patients than in patients with ETI. Logistic regression analysis revealed that the submandible angle was a significant and independent variable associated with DTI among the craniofacial dimensions for both sexes. The specific craniofacial features were visually more evident in the profile in than frontal composites.

Increased submandible angle characterizes craniofacial features of patients with DTI.