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BJA Advance Access published online on July 8, 2005
British Journal of Anaesthesia, doi:10.1093/bja/aei190
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2005. All rights reserved. For Permissions, please e-mail: journal.permissions@oupjournals.org
Accepted June 6, 2005

Clinical Investigation

Reduction in mouth opening with semi-rigid cervical collars{dagger}

C. M. Goutcher 1* and V. Lochhead 1

1 Department of Neuroanaesthesia, Institute of Neurological Sciences, Southern General Hospital, 1345 Govan Road, Glasgow G51 4TF, UK

* To whom correspondence should be addressed.
C. M. Goutcher, E-mail: c.goutcher{at}ntlworld.com


  Abstract

Background. Reduced mouth opening may be a major contributing factor to the deterioration in the view obtained at laryngoscopy when a semi-rigid cervical collar is in place. We set out to assess the degree to which mouth opening is restricted by a cervical collar.

Methods. We measured maximal inter-incisor distance in 52 volunteers. It was measured again after application of each of three appropriately sized semi-rigid cervical collars (Stifneck, Miami J, and Philadelphia).

Results. Inter-incisor distance was significantly reduced by the application of a cervical collar [No collar 41 (7) mm-mean (SD); Stifneck 26 (8) P<0.0001; Miami J 29 (9) P<0.0001; Philadelphia 29 (9) P<0.0001]. There was a wide and unpredictable variation between subjects in the reduction in mouth opening and a significant proportion had an inter-incisor distance of 20 mm or less (Stifneck, 25%; Miami J, 21%; Philadelphia, 21%).

Conclusions. Application of a semi-rigid cervical collar can significantly reduce mouth opening. This could hinder definitive airway placement. Our results support removing the anterior portion of the collar before attempts at tracheal intubation.

Keywords: airway; assessment, pre-anaesthetic; equipment, collars; intubation, tracheal tube.
{dagger}Presented as a poster at the Difficult Airway Society Annual Scientific Meeting, Leicester, UK, November 25-26, 2004.
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E-letters:

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British Journal of Anaesthesia, 27 Sep 2005 [Full text]
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