To the Editor:—

Contrary to the statement in the letter by Adnet et al.,  1figure 1 does not show a patient in the sniffing position. The sniffing position necessitates approximately 30–35° of flexion of the neck axis on the chest axis. Placing a patient’s head on a pillow is irrelevant if it does not achieve this end point. In figure 1 of the letter by Adnet et al. , 1the neck seems to be flexed on the chest by only 5°. If the neck had been flexed on the chest by approximately 30–35°, the laryngeal axis would be almost identical to the pharyngeal axis, and the laryngeal and pharyngeal axes would be much closer to the oral axis. In addition, flexion of the neck on the chest might have permitted a slightly greater degree of extension of the head axis on the neck axis, thereby further bringing the laryngeal, pharyngeal, and oral axes into alignment. I do not believe that figure 1 of the letter by Adnet et al.  1shows the patient in sniffing position.

Adnet F, Borron SW, Lapostolle F, Lapandry C: The three axis alignment theory and the “sniffing position”: Perpetuation of an anatomic myth? A nesthesiology 1999; 91: 1964–5