To the Editor:—

For orotracheal fiberoptic intubation, an Ovassapian fiberoptic intubating airway has been used to provide an open oropharyngeal space and to introduce a fiberoptic bronchoscope at the midline of the oropharynx. 1When using this device with proper application of the jaw-thrust maneuver and extension of the head and neck, laryngeal exposure is usually easy, even in anesthetized, paralyzed patients. 1,2However, in some patients (e.g. , patients with obesity or with limitations of head and neck extension), the space between the pharyngeal surface of the intubating airway and the soft palate is narrow, despite performance of an adequate jaw-thrust maneuver by an experienced assistant. In these cases, a fiberoptic view is obstructed and identification of the midline is difficult. We pasted a black line on the midline of the pharyngeal surface of the airway (fig. 1).

This line facilitates identification of the midline and advancement of the fiberscope along the midline when the space between the intubating airway and the soft palate is narrow (fig. 2). We have used this modified intubating airway in more than 50 adult paralyzed patients and believe that it is valuable for trainees and instructors in teaching fiberoptic intubation. We believe that this black line is helpful for experienced endoscopists, especially in patients with morbid obesity or in those with limited head and neck extension.

Fig. 1. An Ovassapian airway with a black line pasted on the midline of the pharyngeal surface. 

Fig. 1. An Ovassapian airway with a black line pasted on the midline of the pharyngeal surface. 

Fig. 2. Fiberoptic view in an obese patient. The space between the pharyngeal surface of the Ovassapian airway (OA) and the soft palate (SP) is narrow, despite adequate performance of the jaw-thrust maneuver and extension of the head and neck by an experienced assistant. A black line on the airway facilitates identification of the midline. An arrow indicates the base of the uvula. 

Fig. 2. Fiberoptic view in an obese patient. The space between the pharyngeal surface of the Ovassapian airway (OA) and the soft palate (SP) is narrow, despite adequate performance of the jaw-thrust maneuver and extension of the head and neck by an experienced assistant. A black line on the airway facilitates identification of the midline. An arrow indicates the base of the uvula. 

References 

1.
Ovassapian A: Fiberoptic tracheal intubation in adults, Fiberoptic Endoscopy and the Difficult Airway, 2nd Edition. Edited by Ovassapian A. Philadelphia, Lippincott–Raven Publishers, 1996, pp 71–103
2.
Aoyama K, Yamamoto T, Takenaka I, Sata T, Shigematsu A: The jaw support device facilitates laryngeal exposure and ventilation during fiberoptic intubation. Anesth Analg 1998; 86: 432–4