Combined Ultrasound and Upper Lip Bite Test Assessment of Difficult Laryngoscopy in Obese Patients

The aim of this observational study to evaluate the accuracy of the HMDR combined with the ULBT as a predictor of difficult laryngoscopy in obese patients undergoing elective surgery under general anesthesia, regarding: * Correlation of HMDR-ULBT values with Cormack-Lehane grades during laryngoscopy. * Comparison of HMDR-ULBT with standard HMDR in predicting difficult laryngoscopy.

Inclusion Criteria: * Adult obese patients aged 18 to 65 years. * Both sexes. * American Society of Anesthesiologists (ASA) physical status II- III. * Body Mass Index (BMI) ≥ 30 kg/m² (classified as obese). * Scheduled for elective surgical procedures requiring general anesthesia with endotracheal intubation. * Ability to understand and provide informed written consent. * Cooperative and able to perform the ULBT on command. * Normal dentition (presence of upper and lower incisors to perform ULBT accurately). Exclusion Criteria: * History of maxillofacial trauma, surgery, or congenital facial anomalies affecting mandibular movement or neck anatomy. * Known or suspected difficult airway requiring awake intubation. * Patients with limited neck mobility (e.g., cervical spine disease or immobilization). * Temporomandibular joint disorders or restricted mandibular mobility. * Pregnancy.