The recent article of Racine et al .,1which compared face mask ventilation using mandibular groove and lower lip placement in edentulous patients, was of great interest to us. Although the technique they describe appears interesting, one technical clarification is required regarding face mask ventilation using a lower lip placement with two hands. We believe that such information would be helpful for others who would like to try this technique.

As the authors note, in the presence of persistent air leaks for five consecutive breaths during standard face mask ventilation, they changed its placement to the lower lip by repositioning the caudal end of the face mask above the lower lip. However, the cephalad end of the face mask remained in the same location for both positions.

Our concern is that, if the cephalad end of the face mask is kept at the same location when moving the caudal end of the face mask upward to the site above the lower lip, this action may distort the shape of the face mask and increase its transverse dimension. This action can result in an increased risk of air leaks through the hollow cheeks because of an inadequate external face mask fit.

By comparing the authors' first two figures, one can see that the cephalad end of the face mask is in a different location in these two placements. Therefore, we would like to know in detail the method they use to obtain an adequate seal when the face mask is changed to the lower lip placement and the location of the cephalad end of the face mask is not changed.

In addition to the techniques mentioned by the authors,1readers may wish to learn about a method we prefer. For edentulous patients, we apply a large face mask so that the chin fits entirely inside the face mask with the seal on the caudal surface of the chin, the cheeks fit within the face mask, and the sides of the face mask seal along the lateral maxilla and mandible. If an adequate seal cannot be achieved using a large face mask, placing the moistened gauzes with the suitable size at the hollow cheeks can often improve contact between the cheeks and face mask.2 

Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

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
Xue FS, Liao X: Techniques of face mask ventilation, Modern Airway Management: A Key Technique for Clinical Anesthesia and Critical Care Medicine. Edited by Xue FS. Zheng-Zhou, China: Zheng-Zhou University, 2002, pp 384–6Xue FS. Zheng-Zhou
Zheng-Zhou University