Clinical Assessment between Measurement of Mandibular Condylar Mobility (USG Guided) Versus Maximum Condyle-Tragus Distance in Predicting Difficult Laryngoscopy

Background: Prediction of difficult laryngoscopy remains a critical component of preoperative airway evaluation, as unanticipated airway difficulty can lead to severe complications. Aim and Objective: To compare ultrasound-guided mandibular condylar mobility with traditional airway assessment parameters, inter-incisor gap (IIG), upper lip bite test (ULBT), mandibular protrusion distance, and maximum condyle–tragus distance in predicting difficult laryngoscopy. Methods: This prospective observational study included 90 adult patients undergoing elective surgery under general anaesthesia. Preoperative measurements included ultrasound-guided condylar mobility and four clinical airway tests. Laryngoscopy was performed using a standard technique, and Cormack–Lehane (CL) grading was recorded. CL grade III–IV was defined as difficult laryngoscopy. Diagnostic accuracy was analysed using sensitivity, specificity, predictive values, and odds ratios. Results: The majority [79 (87.8%)] had easy laryngoscopy, and 11 (12.2%) had difficult laryngoscopy. Ultrasound-guided mandibular condylar mobility demonstrated the highest sensitivity (81.8%) and perfect specificity (100%). Maximum condyle–tragus distance and IIG also showed strong diagnostic performance, with sensitivities of 72.7% and 97.5%, respectively, and specificities of 98.7% and 98.7%, respectively. Mandibular protrusion distance and ULBT had perfect specificity (100%) but lower sensitivity (36.4% and 27.3%). All parameters showed significant association with difficult laryngoscopy (p < 0.0001). Conclusion: Ultrasound-guided mandibular condylar mobility is the most accurate single predictor of difficult laryngoscopy, demonstrating superior sensitivity and perfect specificity. However, multivariate analysis showed that no parameter independently predicted difficult laryngoscopy. A combined approach using both ultrasoundbased and conventional tests enhances the reliability of airway assessment and improves preparedness for difficult laryngoscopy.