Q: All of the following predicts difficult bag-mask ventilation (BMV) except? 

A) Mask seal
B) Obstruction or Obesity
C) Age over 55 (due to loss of tissue elasticity)
D) presence of teeth
E) Stiff lungs


Answer:  D

Difficult bag-mask ventilation (BMV) can be predicted during intubation with mnemonic MOANS© 

• Mask seal 
• Obstruction or Obesity
• Age over 55 
• No teeth
• Stiff lungs

Another Mnemonic commonly used is ROMAN

• Radiation or Restriction 
• Obstruction or Obesity or Obstructive Sleep Apnea 
• Mask Seal or Mallampati or Male 
• Age 
• No teeth 

The objective of above question is to highlight the importance of presence or absence of dentures during intubation/BMV. Contrary to popular belief, the presence of teeth is a good sign during intubation for BMV. Teeth provide a good anatomical framework against which the mask can be sealed properly. Patients with denture should be bag mask ventilated with dentures still on and should be removed when an operator is ready to proceed for blade/video laryngoscopy.


 Reference: 

 Conlon NP, Sullivan RP, Herbison PG, et al. The effect of leaving dentures in place on bag-mask ventilation at induction of general anesthesia. Anesth Analg 2007; 105:370.