We read with interest the recent report by Johnson et al.  1about problems encountered during fiberoptic intubations. This study validated our findings from 1989, where we showed that difficulty passing an endotracheal tube over a bronchoscope is most commonly due to contact with the right arytenoid.2Similar to Johnson et al. , we demonstrated that 90° rotation of the tube should be the first maneuver to advance the tube over the arytenoid.2,3We have formally taught this technique to our residents during the past 10 yr.4Of further interest, we have reported that contact with the right aryepiglottic fold is also the most common cause for difficulty in advancing an endotracheal tube using a Bullard laryngoscope.5 

*Baystate Medical Center, Springfield, Massachusetts. neil.roy.connelly@bhs.org

1.
Johnson D, From AM, Smith RB, From RP, Maktabi MA: Endoscopic study of mechanisms of failure of endotracheal tube advancement into the trachea during awake fiberoptic orotracheal intubation. Anesthesiology 2005; 102:910–4
2.
Schwartz D, Johnson C, Roberts J: A maneuver to facilitate flexible fiberoptic intubation (letter). Anesthesiology 1989; 71:470–1
3.
Connelly NR, Kyle R, Gotta J, Calimaran A, Robbins LD, Kanter G, Dunn SM: Comparison of wire reinforced tubes with warmed standard tubes to facilitate fiberoptic intubation. J Clin Anesth 2001; 13:3–5
4.
Dunn S, Connelly NR, Robbins L: Resident training in advanced airway management. J Clin Anesth 2004; 16:472–6
5.
Shulman GB, Nordin NG, Connelly NR: Teaching with a video system improves the training period but not subsequent success of tracheal intubation with the Bullard laryngoscope. Anesthesiology 2003; 98:615–20