Fig. 1. (A ) Fiber-optic view of the larynx during laryngoscopy using the McCoy laryngoscope in a patient with difficult intubation, with the blade in the neutral position. Although the blade tip is correctly placed in the vallecula, the epiglottis is close to the posterior pharyngeal wall, the laryngeal aperture (arrow) is not expanded, and the area is small. The fiber-optic view was similar to that seen during a Macintosh laryngoscopy. Only the epiglottis was visible under direct vision. L = laryngoscope; E = epiglottis; A = arytenoid. (B ) Fiber-optic view of the larynx during laryngoscopy using the McCoy laryngoscope in a patient with difficult intubation, with the blade in the elevated position. When the levered tip of the blade is elevated, the epiglottis is lifted, the laryngeal aperture is expanded, and the glottis is clearly visible through the fiberscope. The laryngeal aperture area seen fiberoptically is markedly expanded by the levered tip of the McCoy blade. Note that only the epiglottis could be seen directly.