Dental mirror is a relief for difficult endotracheal intubation.

To the Editor: Endotracheal intubation is sometimes difficult, especially with laryngoscopy Grades III or IV (Cormack and Lehane grade), because the vocal cords are difficult to observe. A fiberoptic bronchoscope is often recommended for this situation, but we believe that a simple dental mirror is a useful, but rarely mentioned, alternative. We attempted endotracheal intubation in a 74-yr-old man undergoing surgery for lumbar herniation. He had limited mouth opening, poor tongue mobility, and limited neck flexibility secondary to right lower gingival and neck dissection for cancer 4 yr earlier. We observed the patient’s vocal cords behind the epiglottis with a dental mirror (Figs. 1a and b). This permitted proper orientation and direction of the endotracheal tube during intubation, despite a laryngoscopy Grade III. We successfully advanced the endotracheal tube into the trachea, with the guidance of the dental mirror. Dental mirror is a simple, inexpensive, easy-to-sterilize device whose use may decrease the labor and cost associated with fiberoptic bronchoscopy.