Airway Assessment

Figure 5. Retrognathic patient (left) with stylised changes in the orientation of the
primary and secondary curves (right). There is accentuation of the primary curve
resulting in an increased distance between the line of sight and the vertex of the
primary curve. There is accentuation of the secondary curve with clockwise rotation of
the laryngeal vestibule axis.
Figure 6. Patient with a short thyromental distance (left) with stylised changes in
the orientation of the primary and secondary curves (right). There is accentuation of
the primary curve resulting in an increased distance between the line of sight and
the vertex of the primary curve. There is accentuation of the secondary curve with
clockwise rotation of the laryngeal vestibule axis.
II) THE THREE-COLUMN APPROACH TO AIRWAY ASSESSMENT
Airway assessment should be refined to not only identify possible difficult airways but to
identify factors that contribute to potential difficulty and to plan strategies to address these
factors specifically. The positive predictive value of an individual airway assessment test is
inevitably low because of the rarity of the true difficult airway 14,15 . Rather than focusing unduly
on individual or any combination of airway assessment tests, an airway management concept
should be taught that allows an understanding of how the airway passage may be manipulated
to optimise air movement. Airway assessment is critically important, but it must be interpreted
in context, that is for planned intubation, the assessor must endeavour to understand the
implications of the assessment as they apply to the static and dynamic phases of laryngoscopy.
41 Airway Assessment