In fibrescope-aided tracheal intubation, it can be difficult to advance a tube over a fibrescope, because its passage may be impeded by the epiglottis, arytenoids or pyriform fossa. In two patients with difficult intubation, after successful insertion of a fibrescope into the trachea, it was impossible to advance the tube over the fibrescope. Fibrescope-aided tracheal intubation was accomplished by shifting the epiglottis anteriorly and 'opening up' the glottis either by fingers or the McCoy laryngoscope.
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Asai et al. (1998) studied this question.
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