{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T16:44:18Z","timestamp":1787071458650,"version":"build-2736575974"},"reference-count":9,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"Suppl 4","license":[{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Anticipation of a difficult airway is essential for safe anesthesia. Unanticipated difficult intubations remain a major cause of morbidity and mortality in the perioperative period. Several bedside airway assessment tests exist, but their accuracy varies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim:<\/jats:title>\n                    <jats:p>To compare the predictive value of the Modified Mallampati Test (MMT), Upper Lip Bite Test (ULBT), and Thyromental Distance (TMD) against the Cormack\u2013Lehane (CL) grading for predicting difficult intubation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>A prospective observational study was conducted on 150 ASA I\u2013II patients (18\u201360 years) scheduled for elective surgery under general anesthesia. Preoperative airway assessment included MMT, ULBT, and TMD performed by a single anesthesiologist. Direct laryngoscopy was performed under standardized anesthesia, and CL grades were recorded. Grades III\u2013IV were considered difficult intubation. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of each bedside test were calculated using CL grading as the gold standard.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Difficult intubation was encountered in 20 patients (13.33%), with 18 graded CL III and 2 graded CL IV. Sensitivity and specificity were: MMT \u2014 45% and 96.15%; TMD \u2014 65% and 94.61%; ULBT \u2014 80% and 96.92%. ULBT showed the highest predictive accuracy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>ULBT demonstrated superior sensitivity and specificity among the tests evaluated, but no single bedside test was sufficiently accurate to predict all difficult intubations. A combination of tests is recommended for preoperative airway assessment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/jpbs.jpbs_1463_25","type":"journal-article","created":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T08:01:24Z","timestamp":1766044884000},"page":"S3019-S3021","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Study to Compare Bedside Tests \u2014 Mallampati Score, Upper Lip Bite Test, and Thyromental Distance \u2014 With Cormack\u2013Lehane Score as Predictors of Difficult Intubation"],"prefix":"10.4103","volume":"17","author":[{"given":"Urmila","family":"Keshari","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology, Gandhi Medical College, Bhopal, Madhya Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ajay","family":"Yadav","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Gandhi Medical College, Bhopal, Madhya Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sherin","family":"Soni","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Gandhi Medical College, Bhopal, Madhya Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vignesh","family":"Rajan","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Gandhi Medical College, Bhopal, Madhya Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bhumika","family":"Panjwani","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Gandhi Medical College, Bhopal, Madhya Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahendra P.","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Gandhi Medical College, Bhopal, Madhya Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,12,17]]},"reference":[{"key":"R1-20251218","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1097\/00000542-200508000-00027","article-title":"Predicting difficult intubation in apparently normal patients: A meta-analysis","volume":"103","author":"Shiga","year":"2005","journal-title":"Anesthesiology"},{"key":"R2-20251218","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/S1875-4597(08)60027-2","article-title":"Comparison of ULBT with TMD","volume":"46","author":"Salimi","year":"2008","journal-title":"Acta Anaesthesiol Taiwan"},{"key":"R3-20251218","doi-asserted-by":"crossref","first-page":"3458","DOI":"10.18410\/jebmh\/2015\/499","article-title":"A study of prediction of difficult intubation using Mallampati and Wilson score correlating with Cormack Lehane grading","volume":"2","author":"Shelgaonkar","year":"2015","journal-title":"J Evidence Based Med Healthcare"},{"key":"R4-20251218","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1111\/j.1365-2044.1987.tb04039.x","article-title":"Difficult tracheal intubation: A retrospective study","volume":"42","author":"Samsoon","year":"1987","journal-title":"Anaesthesia"},{"key":"R5-20251218","doi-asserted-by":"crossref","first-page":"3","DOI":"10.4103\/0972-5229.173678","article-title":"Comparison of upper lip bite test and ratio of height to thyromental distance with other airway assessment tests for predicting difficult endotracheal intubation","volume":"20","author":"Badheka","year":"2016","journal-title":"Indian J Crit Care Med"},{"key":"R6-20251218","doi-asserted-by":"crossref","first-page":"1105","DOI":"10.1111\/j.1365-2044.1984.tb08932.x","article-title":"Difficult tracheal intubation in obstetrics","volume":"39","author":"Cormack","year":"1984","journal-title":"Anaesthesia"},{"key":"R7-20251218","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1213\/00000539-200302000-00053","article-title":"ULBT vs Mallampati","volume":"96","author":"Khan","year":"2003","journal-title":"Anesth Analg"},{"key":"R8-20251218","doi-asserted-by":"crossref","first-page":"191","DOI":"10.4103\/0970-9185.111700","article-title":"Predictive value of ULBT","volume":"29","author":"Shah","year":"2013","journal-title":"J Anaesthesiol Clin Pharmacol"},{"key":"R9-20251218","doi-asserted-by":"crossref","first-page":"915","DOI":"10.1007\/s10877-017-0090-3","article-title":"Can thyromental distance be measured accurately?","volume":"32","author":"Wang","year":"2018","journal-title":"J Clin Monit Comput"}],"container-title":["Journal of Pharmacy and Bioallied Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/jpbs.jpbs_1463_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T15:46:26Z","timestamp":1787067986000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/jpbs.jpbs_1463_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12]]},"references-count":9,"journal-issue":{"issue":"Suppl 4","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.4103\/jpbs.jpbs_1463_25","relation":{},"ISSN":["0976-4879","0975-7406"],"issn-type":[{"value":"0976-4879","type":"print"},{"value":"0975-7406","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12]]},"assertion":[{"value":"2025-08-15","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication 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