A comparison of different airway assessment methods in predicting difficult intubation: Lower jaw protrusion manoeuvre and neck extension versus thyromental distance and modified Mallampati test

Abstract Background: A proper airway assessment plays a vital role in preventing airway-related adverse effects. Methods: This prospective study was conducted during the period January-March 2024 to compare the performance of combination of modified Mallampati test (MMT) and thyromental distance (TMD) versus lower jaw protrusion manoeuvre (LJPM) with neck extension (NE) in association with modified Cormack–Lehane grading in predicting difficult intubation (DI). Seventy patients undergoing tracheal intubation posted for elective surgeries under general anaesthesia were studied. Results: DI was encountered in 11%. A significantly higher AUC was evident with LJPM 0.70 (95% confidence intervals [CI] 0.60-0.8) compared with NE 0.67 (95% CI 0.55-0.78), MMT 0.62 (95% CI 0.50-0.74) and TMD 0.58 (95% CI 0.46-0.70) respectively. Significantly higher AUC was evident with combination of NE + LJPM 0.69 (95% CI 0.57-0.80) compared to TMD + MMT 0.61 (95% CI 0.49-0.73). Conclusions: Our observations suggest that the combination of NE and LJPM was a better predictor of DI than the MMT and TMD.