Ultrasound-guided evaluation of airway difficulty in morbid obesity: Comparative predictive parameters

Ultrasound assessment of anterior neck soft tissue thickness is a promising tool for predicting difficult laryngoscopy, particularly in obese patients. Hence, we evaluated 40 obese individuals (BMI > 35) undergoing elective surgery, comparing ultrasonographic measurements at the hyoid bone (DSHB), thyrohyoid membrane (DSEM), and anterior commissure (DSAC) with conventional airway predictors. Difficult laryngoscopy, defined as Cormack-Lehane grade III-IV, was significantly associated with increased mean values of DSHB (p < 0.0001), DSEM (p< 0.0001) and DSAC (p< 0.002) respectively. Among conventional predictors, only the Modified Mallampati Score showed a significant correlation (p < 0.017). Ultrasonography of anterior neck soft tissues appears to be a reliable and independent predictor, potentially improving preoperative airway assessment in obese patients when combined with standard methods.