Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 2 2026 02 22 126 131 Masoud Borjian Borujeni Department of Anesthesiology and Critical Care, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. Azim Honarmand Department of Anesthesiology and Critical Care, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. Mohammadreza Safavi Department of Anesthesiology and Critical Care, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. Behzad Nazemroaya Department of Anesthesiology and Critical Care, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. 2025 04 22 2025 05 11 Background: Reflex Given the critical role of anatomical airway structures in tracheal intubation, this study aimed to predict the difficulty of mask ventilation and laryngoscopy using ultrasound-based airway evaluation criteria. Methods: This cross-sectional study involved 205 patients undergoing tracheal intubation. During intubation evaluation based on the Cormack-Lehane classification, neck ultrasound was performed. The diagnostic value of neck sonographic parameters was assessed using receiver operating characteristic (ROC) analysis. Results: According to the Cormack-Lehane classification, intubation was easy in 170 patients (82.9%) and difficult in 35 patients (17.1%). Ultrasound findings revealed statistically significant differences in all parameters, including neck circumference, between the easy and difficult intubation groups. All measured values were higher in the difficult intubation group. Conclusion: The findings suggest that ultrasound is a useful, practical tool for predicting difficult intubation. However, due to study limitations such as the small sample size, further research is recommended. https://aacc.tums.ac.ir/index.php/aacc/article/view/1269