Inclusion Criteria:  Patients requiring oral endotracheal intubation Age 18 years or older  Group A Criteria (need only one of the following criteria)  History of difficult intubation History of head/neck radiation and prior oral cavity, pharyngeal, or laryngeal surgery  Group B Criteria (need three or more of the following)  Thyromental distance <6 cm (Defined as distance measured from the thyroid notch to the tip of the jaw with the head extended and the mouth closed) Sternomental distance < 12 cm (Defined as distance measured as the straight line between the upper border of the manubrium sterni and the bony point of the mentum with the head in full extension and the mouth closed Oropharyngeal view: modified Mallampati scale of 3 or 4 Mouth opening < 4 cm Protruding upper teeth (severe overbite) History of radiation to the neck Limited neck movement: inability to extend and flex neck >90° from full extension to full flexion or presence of cervical spine pathologies and fractures (e.g., C-collar in place) Body Mass Index (BMI) >35 kg/m2 Neck circumference .> 40 cm in females and 43 cm in males measured at the thyroid cartilage Obstructive sleep apnea diagnoses or a STOP BANG score 6 and above  Exclusion Criteria:  Any patient under the age of 18 Full stomach, Untreated hiatal hernia Uncontrolled gastroesophageal reflux disease Known tracheal narrowing