Association between upper airway computed tomography measurement parameters and mask ventilation in patients undergoing oral and maxillofacial surgery.

BACKGROUND

Difficult mask ventilation (DMV) poses significant perioperative challenges, particularly in oral and maxillofacial surgery. Maxillofacial computed tomography (CT) imaging may offer improved airway assessment. This study aimed to identify those preoperative midsagittal CT parameters associated with DMV in this high-risk patient population.

METHODS

A retrospective cohort study was conducted that analyzed patients undergoing oral and maxillofacial surgery, with 21 anatomical parameters being measured on preoperative midsagittal CT scans. Multivariable logistic regression, adjusted for demographic characteristics, medical history, and traditional airway assessment parameters, was used to identify independent predictors of DMV. Subgroup analyses were performed for significant parameters.

RESULTS

Among 449 participants included in the study, the incidence of DMV was 17.3%. Three CT parameters independently predicted DMV: anteroposterior diameter of the neck (dAP) [odds ratio (OR): 1.08; 95% confidence interval (CI): 1.03-1.13; P=0.003), uvula length (LU) (OR: 1.10; 95% CI: 1.03-1.18; P=0.008), and distance between the posterior nasal spine and the nasopharynx (Snp_Nph) (OR 0.92; 95% CI: 0.85-0.99; P=0.027). LU showed a stronger association with DMV in snoring patients (P for interaction=0.039) and Mallampati class I-II cases (P for interaction =0.038), while Snp_Nph showed a stronger association with DMV in patients with a body mass index (BMI) >24 kg/m2 (P for interaction =0.050).

CONCLUSIONS

Neck morphology and uvular characteristics significantly influence DMV risk. Preoperative CT measurement of dAP, LU, and Snp_Nph may enhance DMV prediction, improving airway management in oral and maxillofacial surgery.