We would like to thank Xue et al . for their comments on the placement techniques we recently described1for face mask ventilation in edentulous patients. Their concerns focused on the exact position of the cephalad end of the mask.

In our original description, we stated that the cephalad end of the mask stayed in the same location when moving the mask's caudal end above the lower lip. In fact, the cephalad end of the mask may shift upward slightly, as shown in our original figures.

The alternative approach proposed by Xue et al .—using a larger face mask to rule out reduced contact with the cheeks—is an interesting one. We would like to see a demonstration of the effectiveness of this proposed technique in reducing air leaks. Why not share our interest in this topic by conducting a multicenter trial?

We also thank Roth for his comments. Based on his experience, he reports that, in some patients, lower lip face mask placement with the cephalad end of the mask on the eyes may cause ocular damage. Roth recommends using the head straps to improve contact between the mask and cheeks.

In our own experience, we have found that the head straps themselves may promote ocular damage and, therefore, should be used with caution. Also, we are convinced that the problem of air leak at the cheeks is best solved by moving the contact points rather than increasing pressure. However, as airway obstruction contributes to air leak, we fully agree with Roth that the use of an oral airway is one of the keys to improving face mask ventilation in edentulous patients.

Why not conduct a formal comparison among head-strap–adjusted face masks, larger face masks, and lower lip positioning of masks in edentulous patients?

Avicenne University Hospital, Bobigny, France. christophe.baillard@avc.aphp.fr

Racine SX, Solis A, Hamou NA, Letoumelin P, Hepner DL, Beloucif S, Baillard C: Face mask ventilation in edentulous patients: A comparison of mandibular groove and lower lip placement. Anesthesiology 2010; 112:1190–3