Related Experiment Video
Updated: Jul 9, 2025
Point-of-Care Ultrasound: A Review of Ultrasound Parameters for Predicting Difficult Airways
Published on: April 7, 2023
Predictive underestimation of difficult direct laryngoscopy in a patient with rheumatoid arthritis-associated
Hirotaka Matsuyama1, Masato Hara2, Atsushi Seto3
1Department of Anesthesiology, Kurume University School of Medicine, 67 Asahi-Machi, Kurume, Fukuoka, 830-0011, Japan.
Background:
The upper cervical spine is a major focus of damage by rheumatoid arthritis (RA). Specific screening for mobility of the upper cervical spine, which is essential for direct laryngoscopy, is lacking. Herein, we present a case of RA with Cormack-Lehane grade IV, which was not predicted by preoperative examination.
Case Presentation:
A 66-year-old woman with RA was scheduled for a right total knee arthroplasty and right elbow synovectomy. She had a long history of RA without symptoms related to the cervical spine or spinal cord. Although physical examination suggested moderate risk of difficult intubation with preserved cervical retroflexion, her Cormack-Lehane classification was grade IV under muscle relaxation. Bony integration of the occiput to axis was considered to be the main cause of difficult direct laryngoscopy, and restricted neck rotation was found postoperatively.
Conclusions:
RA patients may have limited upper cervical spine motion despite normal cervical retroflexion.
