![]() Neck extension is the most important maneuver, and simple extension may be as effective as the “sniffing” position in achieving an optimal laryngeal view. Neck mobility is desirable for any intubation technique and is essential for positioning the patient for optimal direct laryngoscopy. Conditions such as epiglottitis, head and neck cancer, Ludwig’s angina, neck hematoma, foreign body or thermal injury can compromise laryngoscopy, the passage of the endotracheal tube (ETT), BMV, or all three. This may present as stridor, inability to swallow secretions or alteration in voice quality. ![]() Upper airway obstruction can make visualization of the glottis, or intubation itself, mechanically impossible. Class I and class II predict adequate oral access, class III predicts moderate difficulty, and class IV predicts a high degree of difficulty. Visibility of the oral pharynx ranges from complete visualization, including the tonsillar pillars (class I), to no visualization at all, with the tongue pressed against the hard palate (class IV).
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