Certain conditions make endotracheal intubation with existing laryngoscopes far from ideal, and occasionally impossible. Patients with anatomical abnormalities which limit range of motion in the cervical spine or temporomandibular joint, or both, may require a tracheostomy solely for the purpose of providing airway control during anesthesia. The solution for these difficult intubations seemed to be a method that would employ a guide over which an endotracheal tube could be passed.
A review of the literature revealed the use of several types of guides, such as a retrograde translaryngeal catheter,1-3 a transnasal suction catheter,4 or a 5-mm pediatric bronchoscope inserted behind the molar teeth. However, in patients with severe rheumatoid disease we find the larynx fixed in a more anterior position and at a greater angle to the pharynx than is usual, thus making all of these methods unsuccessful.
With the cooperation of the IIT Research Institute, Chicago, a