Ethnic considerations in the upper lip bite test: the reliability and validity of the upper lip bite test in predicting difficult laryngoscopy in Koreans

Jong Chan Kim, Yumin Ki, Jihee Kim, So Woon Ahn, Jong Chan Kim, Yumin Ki, Jihee Kim, So Woon Ahn

Abstract

Background: Several methods have been used to predict difficult tracheal intubation. Among recently suggested methods, the upper lip bite test (ULBT) could serve as a good predictor. Soft tissue and skeletal hard tissue profiles are affected by many factors including ethnicity. We aimed to assess the clinical utility of the ULBT in Koreans while considering ethnic differences.

Methods: Three-hundred-forty-four Korean patients undergoing general anesthesia with orotracheal intubation were included. Preoperatively, we recorded the patient's Modified Mallampati (MMT) classification, ULBT ratings, and the Cormack-Lehane grade.

Results: The area under the receiver operating characteristic (ROC) curve (AUC) was lower for the ULBT than the MMT (95% confidence interval: 0.0697-0.191, p < 0.0001). The ULBT showed high accuracy (73.83%) and specificity (98.04%). On the other hand, the ULBT showed significantly lower sensitivity (4.49%). Only nine of 344 Korean patients could not bite their upper lip; among them, only three presented a difficult laryngoscopic view.

Conclusions: One factor related to the low sensitivity is the low incidence of a grade III ULBT in Koreans. In Asians, the scarcity of a grade III ULBT is explainable as a result of anteriorly displaced temporomandibular joints and redundant lip soft tissues. Despite its high specificity, the low sensitivity and AUC of the ULBT mean that the test results should be interpreted cautiously in Koreans. Ethnic differences should be considered when evaluating parameters related to soft tissues such as the ULBT.

Trial registration: ClinicalTrials.gov Identifier: NCT01908218, Date of registration JUL 2013.

Conflict of interest statement

Ethics approval and consent to participate

After obtaining approval from the Severance Hospital Institutional Review Board (IRB number: 4–2008-0583), the trial was performed at Yonsei University Severance Hospital. The written informed consent was obtained from all subjects participating in the trial.

Consent for publication

Not applicable.

Competing interests

The authors have no conflicts of interest.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow chart of patient participation
Fig. 2
Fig. 2
ROC curves of MMT and ULBT

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