Figure 2.

A representation of the anatomical “path to intubation.” The supralaryngeal tract spans from the lips to the level of the hyoid bone (yellow path). It corresponds to the supralaryngeal tract as the term has been understood in the context of speech articulation. From the perspective of laryngoscopy, the supralaryngeal tract can be considered as three columns. The suprahyoid tissue envelope (anterior column) consists of all of the soft and bony tissues in front of the air column including the maxillary arch; the air column (middle column), is the air passageway itself; and the cervical spine (posterior column) consists of the bones, joines and ligaments of the cervical spine and the cranio-cervical articulation.² The CT scan images of the suprahyoid tissue envelope denote retrognathia and an adipose neck. These will interfere with the laryngoscopist's ability to compress and displace soft tissues into the neck. The CT scan representing the air column shows a base of tongue tumor which can obscure and distort laryngeal exposure and increase the risk of contact bleeding. The CT scan corresponding to the cervical spine is of a hangman's fracture which prevents spinal manipulation.²⁸ The laryngotracheal conduit can be divided into the laryngeal inlet and the infraglottic conduit. The CT scan and endoscopic images representing laryngeal inlet are of a patient with an advanced laryngeal cancer who presented with acute airway obstruction. The CT scan and endoscopic images representing the infraglottic conduit are of a patient who presented with acute airway obstruction due to a pedunculated tracheal squamous cell carcinoma.