The epiglottis is the bridge from where laryngoscopy starts, namely the tongue, to the objective the glottic opening. Always identifying the epiglottis first is essential for proper landmark recognition and responding to poor laryngeal view.

External laryngeal manipulation, or bimanual laryngoscopy, correctly sits the tip of the curved blade fully into the valeculla. ELM also drives the larynx downwards into better alignment with the laryngoscopist's line of sight. It is best done by the operator, connecting minor movements of the operator's right hand on the thyroid cartilage with directly observed changes in laryngeal view. An assistant can take over once the view is optimized, permitting the laryngoscopist to pass the tracheal tube.

The videotape features a number of custom designed graphic images highlighting the differences between the the appearance of critical structures.

The posterior cartilages and interarytenoid notch separate the dark glottic opening (upwards, immediately beneath epiglottis edge) and the esophagus (below, not seen). Recognizing these structures (even when the true vocal cords cannot be seen) will permit successful intubation in cases of poor laryngeal view.

Excellent tongue control and proper positioning of the curved blade tip in the vallecula provides an excellent laryngeal view.

Comparative views of the esophagus (left) and the glottic opening (right) in the same patient. Note that the glottic opening is immediately beneath the epiglottis, whereas this is not the case on the left. The esophagus is a relatively round hole without adjacent structures; posterior to the glottic opening are the recognizable landmarks of the interarytenoid notch and posterior cartilages.

A laryngoscopy suspension apparatus is used to evaluate the effect of stylet shape on target visualization and maneuverability. Lateral radiographs permit analysis of how a straight to cuff stylet shape performs better than a gently curved stylet.

With a straight-to-cuff stylet shape the midsection of the tracheal tube and stylet passes beneath the maxilla and upper dentition. The distal tip of the tube and stylet is directed upwards at the larynx and maneuverability within the hypopharynx is improved.

Airway Cam imaging of stylet shaping using laryngoscopy suspension shows the visible distal tip of the tracheal tube angling upwards into the larynx. The target is not obscured by the midsection of the tube which is beneath the line of sight of the laryngoscopist. Proper stylet shaping is essential for avoidance of esophageal intubation.