Upper lip bite test in a patient with McCune Albright syndrome with acromegaly

We report a patient with McCune Albright syndrome with acromegaly and features predictive of difficult airway except a class I upper lip bite (ULB) test. Our patient, a 33-year-old woman, had a history of polyostotic fibrous dysplasia. Tracheal intubation was performed under general anaesthesia. Although we did not find any difficulty in visualizing the glottis by direct laryngoscopy; our patient had multiple poor predictive signs of airway assessment including a Mallampati grade III, restricted neck movement and macroglossia. Our report suggests that the ULB test in people with acromegaly may act as an indicator of easy intubation in spite of other poor predictive signs. However, this finding needs further corroboration by a large study to evaluate the role of the ULB test in people with acromegaly.