Predictors of Difficult Laryngoscopy on Computed Tomography in Patients with Faciomaxillary Injury - A Prospective, Observational Study

Airway management of patients with maxillofacial trauma poses serious challenges due to disarranged anatomy as well as associated injuries, haemorrhage, and edema, with almost 24-30% incidence of difficult laryngoscopy and/or intubation. Therefore, accurately predicting challenging laryngoscopy is vital to reduce adverse outcomes and improve patient safety.

Traditional airway assessment methods—such as measuring inter-incisor and thyromental distances, using the modified Mallampati Score, evaluating neck mobility, and performing the upper lip bite test—are often unreliable, demonstrating poor predictive power, sensitivity, and specificity. These bedside evaluations may be impractical in patients with facial maxillary injuries (FMI) due to their altered external anatomy, swelling, blood or secretions, extreme pain, and sometimes cervical spine injuries.

As a result, there is an urgent need for objective predictors of difficult laryngoscopy. Previous studies have shown that radiological assessments, particularly sonography and CT imaging, are invaluable for airway evaluation. However, ultrasound can be challenging and uncomfortable for patients due to local edema. We propose that CT-guided parameters, including both airway characteristics and fracture types, can reliably predict difficult laryngoscopy in individuals with faciomaxillary trauma. Hence we have planned this study with the aim of determining radiological (CT imaging) predictors, including both airway parameters as well as type of fractures, of difficult laryngoscopy in patients with faciomaxillary injury.