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Thyromental Height: A New Clinical Test for Prediction of Difficult Laryngoscopy

Etezadi, Farhad MD; Ahangari, Aylar; Shokri, Hajar; Najafi, Atabak MD; Khajavi, Mohammad Reza MD; Daghigh, Mahtab MA; Moharari, Reza Shariat MD

doi: 10.1213/ANE.0b013e3182a8c734
Patient Safety: Research Report

BACKGROUND: The incidence of difficult laryngoscopy is reported in the range of 1.5% to 20%. We hypothesized that there is a close association between the occurrence of difficult laryngoscopy and the height between the anterior borders of the mentum and thyroid cartilage, while the patient lies supine with her/his mouth closed. We have termed this the “thyromental height test” (TMHT). Our aim in this study was to determine its utility in predicting difficult laryngoscopy.

METHODS: Three hundred fourteen consecutive male and female patients aged ≥16 years scheduled to undergo general anesthesia were invited to participate. Airway assessments were performed with the modified Mallampati test, thyromental distance and sternomental distance, and TMHT in the preoperative clinic. Afterward, Cormack and Lehane grade of laryngoscopy views was assessed during intubation. The laryngoscopist was unaware of airway assessments. As a primary end point, the validity and prediction indexes for the TMHT were calculated. Calculation of validity indexes for the 3 other methods of airway assessment was a secondary objective of this study.

RESULTS: The optimal sensitivity and specificity values were in the range of 47.46 to 51.02 mm. To facilitate clinical application, a cutoff value equal to 50 mm was chosen. TMHT was more accurate than the other tests (all P < 0.0001).

CONCLUSIONS: The TMHT appears to be a more accurate predictor of difficult laryngoscopy than the existing anatomical measurements.

From the Department of Anesthesiology, Tehran University of Medical Sciences (TUMS), Tehran, Iran.

Accepted for publication July 31, 2013.

Funding: Not funded.

The authors declare no conflicts of interest.

Reprints will not be available from the authors.

Address correspondence to Reza Shariat Moharari, MD, Department of Anesthesiology, Tehran University of Medical Sciences (TUMS), Sina Hospital, Hassan Abad Sq., Tehran, Iran. Address e-mail to

© 2013 International Anesthesia Research Society