Pre-operative evaluation of the airway is a key aspect of anaesthesia preparation. While bedside assessments like the Mallampati score, thyromental distance, & neck flexibility offer important insights, they might overlook minor anatomical restrictions. Imaging techniques—particularly CT & MRI—provide enhanced visualization of airway structures & can detect clinically asymptomatic lesions.

Laryngeal conditions, regardless of being inflammatory, neoplastic, or functional, frequently necessitate imaging for accurate assessment. This research assesses the diagnostic role of imaging techniques in pre-anaesthetic evaluation of the upper airway & identification of laryngeal pathologies within a group of 100 patients.

The upper airway is a highly intricate anatomical area that can be influenced by different medical conditions. The upper airway consists of the nose, nasopharynx, oropharynx, hypopharynx, larynx, & trachea, & these components can be affected by both localized & widespread conditions. Numerous nearby bony & soft tissue structures are equally intricate in their anatomical configuration. While the superficial or mucosal reach of airway lesions can be partially observed during a physical exam & more thoroughly via endoscopy, the submucosal & deeper structure can be precisely assessed only through imaging. Consequently, diagnostic imaging is crucial in patient evaluation due to its capability to both pinpoint & define conditions that are frequently hidden during physical exams.

Despite the ongoing advancements in diagnostic imaging methods & technologies, particularly with the emergence of cross-sectional imaging techniques like computed tomography (CT) & magnetic resonance imaging (MRI), radiography continues to play a significant role, particularly in the preliminary assessment. Radiography is easily accessible & often serves as the first test preferred for pediatric patients, especially when foreign body aspiration is suspected. Adults are often initially evaluated with standard X-rays to check for retained foreign objects or other reasons for sudden upper airway obstruction.

MATERIAL AND METHODS

• Total patients: 100
• Group A (Pre-anaesthetic evaluation): 50 patients
• Group B (Laryngeal afflictions): 50 patients

Inclusion Criteria

• Adults aged 18–75 years
• Indicated for elective surgery requiring anaesthesia (Group A)
• Patients with hoarseness, stridor, dysphagia, or suspected laryngeal lesions (Group B)

Exclusion Criteria

• Previous laryngeal surgery
• Tracheostomy
• Unstable patients unsuitable for imaging
• Pregnancy (for CT subgroup)

Imaging Modalities Used

• CT neck
• MRI neck
• Flexible fibreoptic laryngoscopy (all patients).

Table 1: Patient Demographics

Table 2: Imaging Findings in Pre-Anaesthetic Evaluation (Group A)

Table 3: Laryngeal Pathologies Detected (Group B)

Table 4: Diagnostic Performance of Imaging vs Clinical Examination

• Imaging modified anaesthetic airway strategy in 28% of pre-anaesthetic patients.
• CT identified significant airway lesions that were missed clinically in 18%.
• Laryngoscopy remained superior for mucosal & vocal-cord mobility assessment.
• MRI provided best soft-tissue resolution for benign laryngeal masses.

This prospective research shows that imaging greatly enhances diagnostic precision in pre-anaesthetic assessments & the evaluation of laryngeal conditions. CT imaging offered an extensive evaluation of airway openness, soft-tissue imbalance, narrowing, & bone irregularities. These results impacted anaesthetic management in over a quarter of cases, highlighting the importance of imaging when a challenging airway is anticipated.

Laryngeal imaging proved to be especially useful in detecting inflammatory & neoplastic abnormalities. Although flexible laryngoscopy is crucial for dynamic evaluations, cross-sectional imaging offers a precise anatomical outline & staging when lesions progress beyond the laryngeal inlet.

The research supports the additional function of imaging in conjunction with clinical evaluation & recommends integrating routine imaging for high-risk or symptomatic individuals.

CT is still the benchmark for imaging bone structures & evaluating airway clearance. MRI excels in assessing soft tissue, rendering it perfect for tumor characterization. Ultrasound, while reliant on the operator's skill, provides a dynamic & non-invasive evaluation that is especially valuable in the preoperative context.

Results from this study align with earlier research indicating that imaging can greatly influence management approaches & enhance patient safety. The selection of modality should be customized according to clinical presentation, suspected condition, & accessibility.

Managing a distorted upper airway linked to head & neck issues can be difficult because of its complex anatomy. Conventional teaching usually involves textbooks & cadaver dissections, requiring considerable time & effort. The assessment of the airway through fiberoptic laryngoscopy, CT, & MRI has led to reliable advancements in guiding the management of challenging airway situations. Nonetheless, recent advancements in 3D reconstructions—including volume rendering, virtual reality, augmented reality, cinematic rendering, 3D modeling, & 3D printing—are increasingly utilized to strategize intricate cases, providing new insights into challenging head & neck tumors. Ultrasound of the upper airway is useful in managing airways due to its ease of access & non-invasive nature. A limitation of ultrasound imaging is that it only visualizes the anterior structures, & the results are operator-dependent

Imaging of the upper airways plays a critical role in both pre-anaesthetic assessment & diagnosis of laryngeal disorders. CT & MRI significantly enhance detection of anatomical variations & pathologies, often altering clinical & anaesthetic decision-making. Routine imaging should be considered in patients with suspected difficult airways & those presenting with laryngeal symptoms

1. Becker M, Burkhardt K, Dulguerov P, Allal A. Imaging of the larynx & hypopharynx. Eur J Radiol 2008;66:460–479.
2. Lamkin RH, Portt J. An outpatient medical treatment protocol for peritonsillar abscess. Ear Nose Throat J 2006;85:658, 660.
3. Reynolds SC, Chow AW. Severe soft tissue infections of the head & neck: a primer for critical care physicians. Lung 2009;187:271–279.
4. Chaturvedi P, Pai PS, Pathak KA, D’Cruz AK. Radiology quiz case 3: laryngeal tuberculosis. Arch Otolaryngol Head Neck Surg 2005;131: 740, 743–744.
5. Byrd JB, Adam A, Brown NJ. Angiotensin-converting enzyme inhibitorassociated angioedema. Immunol Allergy Clin North Am 2006;26: 725–737.
6. Madani M, Madani F. Epidemiology, pathophysiology, & clinical features of obstructive sleep apnea. Oral Maxillofac Surg Clin North Am 2009;21:369–375.
7. Sittitavornwong S, Waite PD. Imaging the upper airway in patients with sleep disordered breathing. Oral Maxillofac Surg Clin North Am 2009;21:389–402.
8. Ahmed MM, Schwab RJ. Upper airway imaging in obstructive sleep apnea. Curr Opin Pulm Med 2006;12:397–401.
9. Kamalipour, H.; Bagheri, M.; Kamali, K.; Taleie, A.; Yarmohammadi, H. Lateral neck radiography for prediction of difficult orotracheal intubation. Eur. J. Anaesthesiol. 2005, 22, 689–693.
10. Ji, C.; Ni, Q.; Chen, W. Diagnostic accuracy of radiology (CT, X-ray, US) for predicting difficult intubation in adults: A metaanalysis. J. Clin. Anesth. 2018, 45, 79–87.
11. Khan, Z.H.; Arbabi, S. Diagnostic value of the upper lip bite test in predicting difficulty in intubation with head & neck landmarks obtained from lateral neck X-ray. Indian. J. Anaesth. 2013, 57, 381–386.
12. Han, Y.Z.; Tian, Y.; Zhang, H.; Zhao, Y.Q.; Xu, M.; Guo, X.Y. Radiologic indicators for prediction of difficult laryngoscopy in patients with cervical spondylosis. Acta Anaesthesiol. Scand. 2018, 62, 474–482.
13. Gupta, K.; Gupta, P.K. Assessment of difficult laryngoscopy by electronically measured maxillo-pharyngeal angle on lateral cervical radiograph: A prospective study. Saudi J. Anaesth. 2010, 4, 158–162.
14. Kharrat, I.; Achour, I.; Trabelsi, J.J.; Trigui, M.; Thabet, W.; Mnejja, M.; Hammami, B.; Chakroun, A.; Charfeddine, I. Prediction of difficulty in direct laryngoscopy. Sci. Rep. 2022, 12, 10722.