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The Callander laryngoscope blade modification is associated with a decreased risk of dental contact

[La modification Callander de la lame du laryngoscope est associée à un moindre risque de contact avec les dents]

Jaemin Lee, MD^*, Jong H. Choi, MD^*, Yoon K. Lee, MD^*, Eun S. Kim, MD^*, Ou K. Kwon, MD^* and Randolph H. Hastings, MD PhD

^* From the Department of Anesthesiology, School of Medicine, The Catholic University of Korea, Seoul, Korea; and the
Anesthesiology Service, VA San Diego Healthcare System, San Diego, California, USA.

Address correspondence to: Dr. Eun S. Kim, Department of Anesthesiology, School of Medicine, The Catholic University of Korea, Kangnam Saint Mary’s Hospital, 505 Banpo-Dong, Seocho-Gu, Seoul 137-040, Korea. Phone: 82-2-590-1545; Fax: 82-2-537-1951; E-mail: euns1503{at}catholic.ac.kr

Purpose: Dental damage may occur with laryngoscopy. The purpose of this study was twofold: to determine whether preoperative examination could predict the risk of contacting the teeth with the laryngoscope and to evaluate the effectiveness of a modified Macintosh blade on reducing dental contact.

Methods: Four hundred and eighty-three patients scheduled for elective surgery requiring general anesthesia with endotracheal tube placement were studied prospectively. Features that might predict difficult intubation were assessed preoperatively. Laryngoscopy was performed twice on each patient, once with a regular Macintosh 3 blade and once with a blade in which the flange was partially removed (Callander modification). The distance between the flange of the blade and the upper incisors at glottic exposure was measured. We calculated correlations between individual airway characteristics and the chance of hitting the upper teeth with the regular Macintosh 3 blade and compared the frequencies of contacting the teeth between the two blades.

Results: The chance of hitting the upper teeth when using the regular Macintosh 3 blade increased significantly with non-parametric scores for Mallampati classification, mandibular subluxation, head and neck movement, interincisor gap, and condition of the upper teeth. (P < 0.01) The frequency of direct contact varied significantly between the two blades: 20.3% vs 4.1% for Macintosh 3 and modified blades, respectively (P < 0.05). Laryngeal views were improved with the modified blade.

Conclusion: Airway characteristics correlate with the risk of hitting the upper teeth during laryngoscopy. The modified Macintosh blade reduces the risk of contacting the teeth.

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				E. Monaca, N. Fock, M. Doehn, and F. Wappler The Effectiveness of Preformed Tooth Protectors During Endotracheal Intubation: An Upper Jaw Model Anesth. Analg., November 1, 2007; 105(5): 1326 - 1332. [Abstract] [Full Text] [PDF]

				O. Kimberger, L. Fischer, C. Plank, and N. Mayer Lower flange modification improves performance of the Macintosh, but not the Miller laryngoscope blade: [La modification de la partie inferieure du manche ameliore la performance de la lame du laryngoscope Macintosh, mais non celle du Miller.]. Can J Anesth, June 1, 2006; 53(6): 595 - 601. [Abstract] [Full Text] [PDF]