Basic Science and Pathophysiology

An individual’s airway may be rendered ‘difficult’ by:

Poor Preparation:

• Inadequate positioning
• Poor availability of equipment
• Lack of suitable personnel
• Inadequate training

Normal anatomical and physiological variation:

• Facial hair
• Shape of jaw
• Abnormal teeth or lack of teeth
• Limited mouth opening
• Size of tongue
• Length and mobility of neck
• Position of larynx
• Pregnancy

Pathological anatomical variation:

• Soft tissue swelling as a result of burns, allergy/angio-oedema, infection and haematoma
• Maxillofacial trauma
• Cervical spine deformity or immobility, for example ankylosing spondylitis
• Obesity
• Abdominal distension
• Craniofacial syndromes for e.g. Down syndrome, Pierre robin syndrome, etc. [4]

Neck immobilisation

• Neck immobilisation: as in trauma, where you are unable to position the patient with head extended and neck flexed. This makes visualisation of the vocal cords harder. [5]
• Foreign body obstruction

An airway may be rendered difficult by a host of factors both pathological and anatomical.