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Updated: Jun 17, 2025

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Difficult Airway Prediction in Infants with Apparently Normal Face and Neck Features.

Ivana Petrov1,2, Zorana Stankovic1, Ivan Soldatovic2

  • 1University Children's Hospital, Tirsova 10, 11000 Belgrade, Serbia.

Journal of Clinical Medicine
|August 10, 2024
PubMed
Summary

Facial and neck measurements can predict difficult infant airways. Sternomental distance and tragus-to-mouth angle are key indicators for facemask ventilation and intubation challenges.

Keywords:
airway assessmentdifficult airway predictorsdifficult facemask ventilationdifficult intubationinfants

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Area of Science:

  • Anesthesiology
  • Pediatric Medicine
  • Medical Imaging

Background:

  • Predicting difficult airways in infants is crucial for safe anesthesia.
  • Few studies prospectively assess anthropometric predictors in infants with normal-appearing airways.

Purpose of the Study:

  • Identify facial and neck anthropometric predictors of difficult facemask ventilation and intubation in infants.
  • Evaluate the role of specific measurements in pre-anesthetic airway assessment.

Main Methods:

  • Prospective observational study of 97 infants undergoing general endotracheal anesthesia.
  • Collected pre-ventilation and pre-intubation anthropometric and facial measurements.
  • Analyzed measurements against difficult facemask ventilation and intubation outcomes.

Main Results:

  • Difficult facemask ventilation occurred in 15.5%; difficult intubation in 38.1%.
  • Several measurements including sternomental distance (SMD), tragus-to-mouth angle (TMA), and neck length (NL) differed significantly between groups.
  • Hyomental distances (HMDn, HMDe) showed high specificity for difficult intubation; TMA and SMD showed high sensitivity/specificity for difficult facemask ventilation.

Conclusions:

  • Preoperative airway assessment using patient condition and facial measurements is vital.
  • Specific anthropometric parameters serve as valuable predictors for difficult infant intubation and ventilation.
  • These findings can guide anesthetic management and improve patient safety.