Examination of Submental Space as an Alternative Method of Airway Assessment (Submental Sign)

BACKGROUND: Difficult airway especially failed intubation has been associated with a high incidence of mortality and morbidity. Most of mortalities occur when an anaesthesiologist encounters an unanticipated difficult airway. FINDINGS: In 1999, a 23 yr. old, 65 kg weight and 170 cm height female patient had been scheduled for arthroscopy. Despite totally normal airway assessment (thyromental distance, mouth opening, jaw and neck movement ...) I was astonished by encountering a grade IV Cormack - Lehane laryngoscopic view. Tracheal intubation was impossible and ventilation was very difficult. On attempt to attain a better laryngoscopic view, while manipulating submandibular region I encountered a bulky noncompliant submental space (Submental Sign). This event made me more alert regarding this finding. Thereafter I noted for this sign throughout the past years and I found it very helpful. These findings encouraged me to write this report, and suggest a routine examination of submental space in order to keep the safety of the patient at the heart of the care we provide. CONCLUSION: Evaluation of the submental space is suggested as an alternative predictor of difficult airway and routine examination of the submental space is of value in airway assessment.