Retromolar Route Access With and Without A Retromolar Gap

"To facilitate the insertion of the straight blade laryngoscope (Miller #4) the head of the patient will be turned to the left side. The blade will be inserted and then pushed laterally rightwards until the retromolar space will be finally reached. Thereafter the epiglottis will be lifted up in order to achieve the best direct view to the vocal cords and scored according to Cormack \& Lehane .~This score will be assessed at least 2 minutes after muscle relaxation:~1. Once without a backward, upward, rightwards pressure maneuver (=BURB) and immediately thereafter (i.e. 5-10 seconds later):~2. If 100% visualization of the vocal cords is not possible a BURP maneuver will be performed and the scored again.~Intubation will then be performed by the conventional method using a Macintosh blade #3. In the case that intubation with the conventional method is not successful the retromolar technique will be used."