An MRI Study of the Sniffing, Neutral and Extended Head and Neck Positions

The traditional method of tracheal intubation requires the insertion of a laryngoscope into the oral cavity and directly visualisation of the glottis. The traditional head position called the sniffing the morning air position; consisting of lower cervical flexion and extension of the atlanto-occipital joint is commonly used to facilitate tracheal intubation in this manner by aligning the oral axes and providing the operator a view of the glottis. With the advancement of technology, has seen videolaryngoscopes (VL) developed to ease tracheal intubation. With VL, the glottis is seen through a camera connected to a viewing screen either attached to the top of the laryngoscope or connected to a camera screen by cable. One of the main drawbacks with VL is that a good view of the glottis is seen on the screen, but it can be difficult to pass the tracheal tube through the glottis in comparison to the traditional intubation technique described above. One of the main factors the authors suggest is that VL-assisted intubation requires a head and neck position that is different to the sniffing the morning air position. This study aims to assess the oral axes in three different head and neck positions under MRI to assess which positions improve axial alignment the most.