Effect of excessive laryngoscope traction on the view at laryngoscopy

In this photo, a video laryngoscope blade is applying excessive lifting force below the epiglottis rather than properly seated in the vallecula, above the epiglottis. The vocal cords (arrows) can be seen, as can the paired posterior corniculate and cuneiform (often referred to together as the "arytenoid") cartilages (arrowheads). A correctly sited endotracheal tube should appear above the arytenoid cartilages and between the vocal cords.

The entrance to the hypopharynx is also evident in this photo. The lateral walls of the hypopharynx can be elongated and blanched (dashed arrows) with excessive traction, and can therefore be misinterpreted as the glottic opening. This risk would be compounded if the larynx was obscured by placing the tip of the blade distal to and beneath it. For further detail refer to UpToDate content on confirmation of correct endotracheal tube placement.