Evidence map›Paper›PMID 42249633›Full record

Observational studyAnaesthesia2026

Pre-operative three-dimensional face scans for predicting difficult facemask ventilation: a prospective development study.

Viktor A Wünsch, Hannes Bommes, Sofia Germer, Milan Piltan, Philipp Breitfeld, Sarah Latus, Linda Krause, Christian Zöllner, Christopher Gundler, Martin Petzoldt

Abstract readObservational Study
In one paragraph

Observational study in Anaesthesia, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Viktor A WünschDepartment of Anaesthesiology, Centre for Anaesthesiology and Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.ORCID https://orcid.org/0000-0002-2669-0084
Hannes BommesDepartment of Anaesthesiology, Centre for Anaesthesiology and Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
Sofia GermerInstitute for Applied Medical Informatics, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
Milan PiltanDepartment of Anaesthesiology, Centre for Anaesthesiology and Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
Philipp BreitfeldDepartment of Anaesthesiology, Centre for Anaesthesiology and Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
Sarah LatusInstitute of Medical Technology and Intelligent Systems, Hamburg University of Technology, Hamburg, Germany.
Linda KrauseInstitute of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
Christian ZöllnerDepartment of Anaesthesiology, Centre for Anaesthesiology and Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
Christopher GundlerInstitute for Applied Medical Informatics, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
Martin PetzoldtDepartment of Anaesthesiology, Centre for Anaesthesiology and Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.ORCID https://orcid.org/0000-0001-5295-2925

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionFacemask ventilation is a key airway management skill but predicting difficulty can be challenging. Pre-operative three-dimensional face scanning may have diagnostic value. We aimed to identify interpretable facial shape features and to quantify their value for predicting difficult facemask ventilation.

methodsIn this prospective observational single-centre study, pre-operative three-dimensional face scans were obtained, and a structured airway assessment was performed on patients undergoing ear, nose and throat or maxillofacial surgery. The primary outcome was difficult facemask ventilation documented as an alert in the patient health record. After postprocessing, three-dimensional face scans were fitted to an established, non-clinical facial model to identify interpretable shape coefficients. The area under the receiver operating characteristic (AUROC) curve for the DIFFMASK score was calculated before and after enrichment with three facial shape features and the added diagnostic value was assessed using likelihood ratios.

resultsData from 398 patients were analysed. The optimism-corrected AUROC was 0.73 (95%CI 0.65-0.80) for the DIFFMASK score and 0.74 (95%CI 0.66-0.82) for selected facial shape features. Enrichment of the DIFFMASK score with three facial shape features improved goodness of model fit (p = 0.002) and achieved an optimism-corrected AUROC of 0.76 (95%CI 0.68-0.82). Generated face meshes with superimposed colour mapping revealed that morphological features of the nose, lower mandible, neck region and facial convexity were most predictive of difficult facemask ventilation. DISCUSSION: Pre-operative three-dimensional face scans predicted difficult facemask ventilation at least as well as the DIFFMASK score. Integrating the features of three selected facial shapes enriched the DIFFMASK score and improved its diagnostic value. Digital phenotyping can complement traditional clinical assessment.

Indexed as

Airway ManagementFaceImaging, Three-DimensionalMasksPreoperative CareRespiration, ArtificialAdultAgedFemaleHumansMaleMiddle AgedProspective Studiesairway managementfacial recognitionrespiratory systemventilation

Identifiers

PMID42249633
PMCPMC13551139

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.