Abstract:
A laryngoscope is described for inserting into a mouth of a patient having a tongue, the laryngoscope comprising a handle and an elongate blade detachably fixed to the handle in a plane angularly disposed with respect to the longitudinal axis of the handle. The blade includes a stationary portion and a movable portion having a surface for engaging the tongue of the patient, the movable portion mounted to the stationary portion of the blade for rotation about an axis substantially along the longitudinal axis of the blade. An operating member is manipulated by user for rotating the movable portion of the blade, wherein laryngoscopy of the patient by manipulation of the handle includes at least a rotating motion of the movable portion of the blade.

Description:
CROSS-REFERENCES 
       [0001]    This application is related to U.S. provisional application No. 61/677,922, filed Jul. 31, 2012, entitled “Laryngoscope”, and naming Vincent Nacouzi as the inventor, and U.S. provisional application No. 61/790,913, filed Mar. 15, 2013, entitled “Laryngoscope”, and naming Vincent Nacouzi as the inventor. The contents of both provisional applications are incorporated herein by reference in their entirety, and the benefit of the filing dates of the provisional applications are hereby claimed for all purposes that are legally served by such claim for the benefit of the filing dates. 
     
    
     BACKGROUND 
       [0002]    A laryngoscope is described and shown for use in opening an airway for orotracheal intubation and, more particularly, a laryngoscope for simultaneously displacing the tongue muscle and associated tissue for exposing the larynx and the glottis for intubating a patient with an endotracheal tube. 
         [0003]    Oral or nasal endotracheal intubation procedures are commonly employed to secure a controlled airway and to deliver inhalant oxygen, anesthetic gases, and other therapeutic agents into the trachea and lungs of human and veterinary patients. Laryngeal exposure to visualize vocal cords and facilitate airway control through intubation is a key element in anesthesia and emergency medicine rapid sequence intubation. A laryngoscope is a key instrument for intubation procedures. 
         [0004]    A conventional laryngoscope typically includes a handle and a blade. A proximal end of the blade is detachably connected to an end of the handle such that the blade extends generally normally forwardly from the handle in an L-shaped configuration. Many types of laryngoscope blades have been developed, each characterized by blade curvature, the point of such curvature, and the flange structure of the blade. The primary function of the laryngoscope in orotracheal intubation is to open the mouth and expose the larynx in order to facilitate the insertion of the endotracheal tube into the trachea. The laryngoscope blade serves to displace the tongue and allow direct visualization of the vocal cords through the mouth opening. 
         [0005]    During intubation, a patient is often paralyzed with paralytic drugs or unconscious and not spontaneously breathing. With seconds or minutes to secure an airway, the patient is placed in a supine position with the head tilted backwardly. The laryngoscope blade is usually inserted laterally from the right side of the mouth in order to sweep the tongue mass to the left. The blade is then directed medially to engage and deflect the tongue away from the lumen of the pharyngeal outlet for adequate visualization of the vocal cords. The laryngoscope may be further manipulated to expose the glottic opening. The endotracheal tube is then introduced through the mouth and visually advanced, passing between the vocal cords into the subglottic space for securing the airway. Once placement of the endotracheal tube has been achieved, the laryngoscope blade is removed. 
         [0006]    Intubation procedures involving laryngoscopy require training, skill and strength. Much of the effort goes to moving the large mass of the tongue to expose the airway and visualize the vocal cords. Unfortunately, only a small portion of the surface of the conventional blade can be used efficiently to move the tongue. Moreover, during insertion of the laryngoscope, care must be taken to avoid pressure on the teeth and gums of the patient and avoid traumatizing both the oral mucosa and the epiglottis. The process of laryngoscopy requires a levering action with a fulcrum around the upper teeth. This much needed important levering action is limited by the size of the mouth opening and is insufficient for sweeping aside the tongue mass, particularly in view of the distance of the tongue mass from the mouth opening. Because the laryngoscope blade is necessarily formed of a hard, inflexible material, and the manipulation awkward and challenging, dental damage is a potential result when significant pressure is exerted, which all too often is a risk when performing laryngoscopy. This is certainly accentuated in patients with difficult and narrow airways, due their neck length, body habitus, pharyngeal space opening, tongue size and other pertinent variances. 
         [0007]    For the foregoing reasons, and with challenging small and difficult airways, there is a need for a new laryngoscope blade for simultaneously opening the mouth and deflecting the tongue muscle away from the opening of the trachea for exposing and visualizing the larynx and the vocal cords. 
       SUMMARY 
       [0008]    A laryngoscope is described for inserting into a mouth of a patient having a tongue, the laryngoscope comprising a handle and an elongate blade detachably fixed to the handle in a plane angularly disposed with respect to the longitudinal axis of the handle. The blade includes a stationary portion and a movable portion having a surface for engaging the tongue of the patient, the movable portion mounted to the stationary portion of the blade for rotation about an axis substantially along the longitudinal axis of the blade. An operating member is manipulated by user for rotating the movable portion of the blade, wherein laryngoscopy of the patient by manipulation of the handle includes at least a rotating motion of the movable portion of the blade. 
         [0009]    In another aspect, a laryngoscope is described for inserting into a mouth of a patient having a tongue, the laryngoscope comprising a handle and an elongate blade detachably fixed to the handle in a plane angularly disposed with respect to the longitudinal axis of the handle. The blade includes a stationary portion and a pivoting portion pivotally secured to the stationary portion of the blade at a pivot point. A movable portion of the blade having a surface for engaging the tongue of the patient is mounted to the pivoting portion of the blade for rotation about an axis substantially along the longitudinal axis of the blade. An operating member is manipulated by user for rotating the movable portion of the blade, wherein laryngoscopy of the patient by manipulation of the handle includes at least a pivoting motion and a rotating motion of the portions of the blade. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0010]    For a more complete understanding of the laryngoscope, reference should now be had to the embodiments shown in the accompanying drawings and described below. In the drawings: 
           [0011]      FIG. 1  is a front left perspective view of a laryngoscope with a portion of a blade shown in a first position and a second position depicted in dashed lines. 
           [0012]      FIG. 2  is a right side elevation view of the laryngoscope as shown in  FIG. 1  with the portion of the blade shown in the first position and the second position depicted in dashed lines. 
           [0013]      FIG. 3  is an exploded perspective view of the laryngoscope as shown in  FIG. 1 . 
           [0014]      FIG. 4  is a top plan view of a blade for use with the laryngoscope as shown in  FIG. 1   
           [0015]      FIG. 5  is a bottom plan view of the blade as shown in  FIG. 4 . 
           [0016]      FIG. 6  is a rear elevation view of the laryngoscope as shown in  FIG. 1  with the portion of the blade shown in the first position and the second position depicted in dashed lines. 
           [0017]      FIG. 7  is a front elevation view of the laryngoscope as shown in  FIG. 1  with the portion of the blade shown in the first position and the second position depicted in dashed lines. 
           [0018]      FIG. 8  is an exploded perspective view of a second embodiment of a laryngoscope. 
           [0019]      FIG. 9  is a top plan view of a blade for use with the laryngoscope as shown in  FIG. 8 . 
           [0020]      FIG. 10  is a bottom plan view of the blade as shown in  FIG. 9 . 
           [0021]      FIG. 11  is a rear elevation view of the laryngoscope as shown in  FIG. 8  with a portion of the blade shown in a first position and a second position depicted in dashed lines. 
           [0022]      FIG. 12  is schematic cross-section view of the laryngoscope as shown in  FIG. 8  in position for use in a mouth of a patient. 
           [0023]      FIG. 13  is a right side elevation view of a third embodiment of a laryngoscope with a portion of a blade shown in a first position and a second position depicted in dashed lines. 
           [0024]      FIG. 14  is an exploded perspective view of the laryngoscope as shown in  FIG. 13 . 
           [0025]      FIG. 15  is a rear elevation view of the laryngoscope as shown in  FIG. 13  with the portion of the blade shown in the first position and the second position depicted in dashed lines. 
           [0026]      FIG. 16  is schematic elevation view of the laryngoscope as shown in  FIG. 13  in position for use in a mouth of a patient with a portion of the face of the patient removed for clarity. 
           [0027]      FIG. 17  is a rear left perspective view of still another embodiment of a laryngoscope with a portion of a blade shown in a first position and a second position depicted in dashed lines. 
           [0028]      FIG. 18  is an exploded perspective view of the laryngoscope as shown in  FIG. 17 . 
           [0029]      FIG. 19  is a right side elevation view of the laryngoscope as shown in  FIG. 17  with the portion of the blade shown in the second position and the blade in a second position. 
           [0030]      FIG. 20  is a left rear perspective view of the laryngoscope as shown in  FIG. 17  with the blade in a second position. 
           [0031]      FIG. 21  is a left side elevation view of the laryngoscope as shown in  FIG. 17  with the portion of the blade shown in the second position and the blade in the second position. 
           [0032]      FIG. 22  is a rear elevation view of the laryngoscope as shown in  FIG. 17  with the portion of the blade shown in the first position and the second position depicted in dashed lines and the blade in the second position. 
       
    
    
     DESCRIPTION 
       [0033]    Certain terminology is used herein for convenience only and is not to be taken as a limitation on the invention. For example, words such as “upper,” “lower,” “left,” “right,” “horizontal,” “vertical,” “upward,” and “downward” merely describe the configuration shown in the FIGS. Indeed, the components may be oriented in any direction and the terminology, therefore, should be understood as encompassing such variations unless specified otherwise. 
         [0034]    Referring now to the drawings, wherein like reference numerals designate corresponding or similar elements throughout the several views, an embodiment of a laryngoscope is shown in  FIGS. 1-3  and generally designated at  50 . The laryngoscope  50  comprises a cylindrical handle  52  and a blade  54 , the blade  54  including a stationary portion  56  and a tongue deflector  60 . The tongue deflector  60  is rotatable about the longitudinal axis of the blade  54  relative to the stationary portion  56  of the blade  54 . As will be described herein, the tongue deflector  60  may be rotated to an angular position with respect to the stationary portion  56  of the blade  54  by means of an operating lever  62  manipulated by the user. The tongue deflector  60  may optionally be locked in the angular position. 
         [0035]    The handle  52  has a proximal end  66  and a distal end  68 . In one embodiment, the handle  52  is a conventional laryngoscope handle. In certain aspects, the handle  52  may include a power source, such as a battery, as well as other interfaces of mechanical or electrical means known to one of ordinary skill in the art. 
         [0036]    The blade  54  has a proximal end  78  and a distal end  80 . The blade  54  is formed from a substantially rigid material to allow adequate physical retraction of anatomic structures during use of the laryngoscope. Accordingly, the blade  54  may be constructed of metal or metal alloys that are capable of repeated use and for withstanding sterilization between uses. Suitable metal or metal alloys include stainless steel or aluminum. Alternatively, the blade  54  may be constructed of any rigid plastic that is suitable for medical use, or other low cost, sterile material, and may be provided as a single-use, disposable unit. It is understood that the blade  54  may also be made wholly, or in part, of any other suitable rigid material known in the art. Moreover, it is understood that the scope of the invention is not intended to be limited by the materials listed here, but may be carried out using any material which allows the construction and operation of the laryngoscope described herein. 
         [0037]    The proximal end  78  of the blade  54  may be connected to the distal end  68  of the handle  52  in a known manner. In one embodiment, a conventional mechanical interface  58  is provided at the proximal end  78  of the stationary portion of the blade  54  for connection to the handle  52 . More particularly, the mechanical interface  58  comprises an engagement hook, which is sized and positioned to engage a transverse pivot pin of a conventional laryngoscope handle  52 . The mechanical interface  58  is configured to allow the blade  54  to functionally mount to the distal end  68  of the handle  52  for movement with the handle. In one embodiment, the joined handle  52  and blade  54  define an angle of about 90 degrees and can vary up to 110 degrees in some configurations. More particularly, the longitudinal axis of the handle  52  is perpendicular to a plane normal to the tongue-contacting surface  64  of the tongue deflector  60 . In another embodiment, the proximal end  78  of the blade  54  may be attached to the distal end  68  of the handle  52  by screw thread engagement means (not shown). Alternatively, the handle  52  and the blade  54  may be integrally formed together. 
         [0038]    In another aspect, the blade  54  may provide for other mechanical, as well as electrical, interfaces with the handle  52 . In this arrangement, the blade  54  interlocks with the handle  52  in such a way as to make mechanical and electrical communication with the handle. For example, wiring may be provided from the handle  52  to a miniaturized lamp  76  for illumination at or toward the distal end  80  of the blade  54  during use. Alternatively, fiber optic illumination may be employed using fiber optic carriers within the blade  54  that may be supplied by either an external light source or by a conventional light source contained within the handle  52 , or by an internal lamp  76  housed proximally within the blade  54 . The stationary blade portion  56  may also carry, or be adapted to provide, lighting means such as are known in the art for directing light at the distal end  80  of the blade  54 . 
         [0039]    The tongue deflector  60  is an elongated substantially rectangular member ( FIGS. 4 and 5 ) and may be slightly curved upwardly toward the handle  52  at the distal end  80  of the blade  54 . Although the tongue deflector  60  is shown as slightly curved, it is understood that the blade may also be provided in a substantially straight configuration. The tongue deflector  60  is rotatably mounted to the stationary portion  56  of the blade  54  so that the tongue deflector  60  can rotate relative to the stationary portion  56 . As best seen in  FIG. 3 , a rigid rod  86  is provided for actuating the rotation of the tongue deflector  60 . A portion of the rod  86  is fastened longitudinally along the lower surface of the tongue deflector  60 . At least the proximal end  88  of the rod  86  is journaled in a tubular sleeve  92  fixed to the surface of the stationary blade portion  56 . This arrangement allows the tongue deflector  60  and the rod  86  to pivot freely about a rotational axis coincident with the longitudinal axis of the blade  54 . The tongue deflector  60  can thus articulate, which means movement upward, downward, or in a circular or elliptical path along or about the axis of rotation. It is understood that, in one embodiment, the rod  86  can be spring-biased (not shown) to return the tongue deflector  60  to the home position. It is further understood that the tongue deflector  60  may be pivotally mounted to the blade  54  by any conventional means, such as ball and socket joints, hinges, straps, and the like. 
         [0040]    Means are provided for actuating the rotational movement of the tongue deflector  60 . In the embodiment of the laryngoscope  50  shown in  FIGS. 1-7 , the proximal end  88  of the rod  86  is turned outwardly proximally of the sleeve  92  forming the lever  62 . Referring to  FIGS. 6 and 7 , the tongue deflector  60  is pivoted by manually rotating the lever  62  relative to the blade  54 , which simultaneously rotates the rod  86  within the sleeve  92 . Accordingly, a pivoting force can be easily transmitted to the tongue deflector  60  using the lever  62  by the action of the fingers in turning the wrist. Alternatively, the lever  62  can be connected to actuation means (not shown) mechanically or electrically, such as by a programmable logic controller (PLC) or controller with logic to determine which functions to execute to actuate the tongue deflector  60 . The actuation mechanism can be a motor in the handle  52  responsive to an electronic stimulus or a signal. 
         [0041]    In use, rotation of the tongue deflector  60  relative to the stationary portion  56  of the blade  54  causes the tongue-contacting surface  64  of the tongue deflector  60  to move the tongue and associated tissue to expose the vocal cords and the glottis of a patient. The user is typically working from a position above the head of a supine patient. The head of the patient is stabilized and the mouth is opened. For a right-handed user, the handle  52  of the laryngoscope  50  is usually held in the left hand, with the blade  54  oriented downwardly away from the user. The blade  54  is inserted into the mouth of the patient until the distal end of the blade  54  is positioned at the junction between the base of the tongue and the base of the epiglottis. 
         [0042]    With one hand holding the handle  52  of the laryngoscope  50 , the user rotates the-lever  62  using the thumb or fingers of the other hand for rotation of the tongue deflector  60 . When the lever  62  is rotated relative to the blade  54 , the rod  86  and connected tongue deflector  60  are rotated about their rotation axis, causing the tongue deflector  60  to assume an angular position with respect to the stationary portion of the blade  54 . This action sweeps the tongue and exposes the larynx. The tongue deflector  60  functions to hold back tissue that would otherwise obscure the vision of the user and block the airway as well as maintaining airway patency. The user may then intubate the patient. The larynx is visualized off the medial side of the laryngoscope blade  54  where the endotracheal tube or other instruments can be introduced. 
         [0043]    A second embodiment of a laryngoscope is shown in  FIGS. 8-12  and generally designated at  100 . The laryngoscope  100  comprises a blade  102 , including a stationary portion  104  and a tongue deflector  106 . The upper major surface of the stationary portion  104  of the blade  102  is a tongue-contacting surface  103 . The stationary portion  104  of the blade  102  defines a transverse recess  108  intermediate along the length of the blade for receiving the tongue deflector  106 . 
         [0044]    The tongue deflector  106  has a proximal end  110  and a distal end  112 . The tongue deflector  106  is configured to be received, at least partially, in the recess  108  in the stationary portion  104  of the blade  102 . In this configuration, the tongue deflector  106  extends substantially along the length of the blade  102 . The tongue deflector  106  is mounted for rotation about the longitudinal axis of the stationary portion  104  of the blade  102 . In a first, home position of the tongue deflector  106 , the edges of the tongue deflector  106  are abutted flush with the corresponding edges of the stationary portion  104  of the blade  102  defining the recess  108 . The tongue deflector  106  is configured so that a tongue-contacting surface  107  of the tongue deflector  106  is substantially flush with the upper tongue contacting surface  103  of the stationary portion  104  of the blade  102 . The surface of the tongue deflector  106  is shaped so as to provide surface continuity of the blade  102  when the tongue deflector  106  is in the home position. In this arrangement, the tongue deflector  106  provides no greater bulk that might obstruct either the visual field or working access distal to the tongue deflector  106  during an intubation procedure. 
         [0045]    The tongue deflector  106  extends wider than the blade  102  and is generally planar along its length. Referring to  FIGS. 9 and 10 , the proximal end  110  of the tongue deflector  106  is wider than the blade  102  and tapers in a curvilinear manner to the distal end  112  of the tongue deflector  106  where the tongue deflector is the same width as the stationary portion  104  of the blade  102 . Although the outer edge of the blade  102  is shown as slightly curved, it is understood that the blade  102  may also be provided in a substantially rectangular configuration or any other suitable shape. 
         [0046]    As with the previous embodiment of the laryngoscope, the tongue deflector  106  may be rotated to an angular position with respect to the stationary portion  104  of the blade  102  by means of an operating lever  62  manipulated by the user. In this embodiment, an elongate rod  114  is provided having at least a proximal end  116  and a distal end  118  journaled in tubular sleeves  120  fixed to the surface of the blade  102 . This arrangement allows the tongue deflector  106  and the rod  114  to pivot freely about a rotational axis. 
         [0047]    Referring to  FIG. 11 , the tongue deflector  106  may optionally be locked in the angular position. In this embodiment, the lever comprises a curled free end of the rod  114 . An end wall  122  of the blade  102  defines an opening for passing the rod  114  and is adapted to fixedly receive the lever  62  so as to maintain the relative position of the tongue deflector  106  in use. More particularly, the end wall  122  comprises a locking mechanism having a first opening  124  and a second opening  126  adjacent to, and along the path of rotation of the lever  62 . The first opening  124  corresponds to the home position of the tongue deflector  106 . The second opening  126  corresponds to the angular position of the tongue deflector  106  relative to the stationary portion  104  of the blade  102 . The locking mechanism maintains the tongue deflector  106  in a desired angular position relative to the blade  102  by locking the lever  62  and integral rod  114 . The tongue deflector  106  thus remains in position without requiring the hands of the user. Removing the lever  62  from the second opening  126  releases the lever  62  and allows the tongue deflector  106  to return to the original home position flush with the surfaces of the blade  102 . 
         [0048]      FIG. 12  shows this embodiment of the laryngoscope  100  in use, with the tongue deflector  106  rotated relative to the stationary portion  104  of the blade  102  causing the tongue-contacting surface  107  of the tongue deflector  106  to move the tongue and associated tissue to expose the vocal cords and the larynx of a patient. 
         [0049]    A third embodiment of a laryngoscope is shown in  FIGS. 13-16  and generally designated at  150 . The laryngoscope  150  comprises a blade  152 , including a stationary portion  154  and a tongue deflector  156 . In this embodiment, the stationary portion  154  of the blade  152  has an upper tongue-contacting surface  153  beginning at a distal end  158  and extending to a point intermediate along the length of the blade  152 . The tongue deflector  156  is substantially rectangular and no wider than the blade  152  and is generally planar along its length. The tongue deflector  156  is positioned proximally of the tongue-contacting surface  153  of the stationary portion  154  of the blade  152  and extends substantially along the length of the proximal end  160  of the blade  152 . 
         [0050]    The tongue deflector  156  is rotatable about the longitudinal axis of the stationary portion  154  of the blade  152 . In a first, home position of the tongue deflector  156 , the edges of the tongue deflector  156  are abutted flush with the corresponding edges of the stationary portion  154  of the blade  152 . The tongue deflector  156  is configured so that a tongue-contacting surface  157  of the tongue deflector  156  is substantially flush with the upper tongue contacting surface  153  of the stationary portion  154  of the blade  152 . The surface of the tongue deflector  156  is shaped so as to provide surface continuity with the blade  152  when the tongue deflector  156  is in the home position. In this arrangement, the tongue deflector  156  provides no greater bulk that might obstruct either the visual field or working access distal to the tongue deflector  156  during an intubation procedure. 
         [0051]      FIG. 16  shows the third embodiment of the laryngoscope  150  in use, rotating the tongue deflector  156  relative to the stationary portion  154  of the blade  152  causing the tongue-contacting surface  157  of the tongue deflector  156  to move the tongue and associated tissue to expose the vocal cords and the larynx of a patient. 
         [0052]    A fourth embodiment of a laryngoscope is shown in  FIGS. 17 and 18  and generally designated at  200 . The laryngoscope  200  comprises a blade  202 , including a stationary portion  204  and a pivoting portion  206  joined at a pivot point  203 . The pivoting portion  206  of the blade  202  comprises a rotating tongue deflector  208 . In this embodiment of the laryngoscope  200 , the pivoting portion  206  of the blade  202  has an upper tongue-contacting surface  207  beginning at a distal end of the blade  202  and extending to a point intermediate along its length. The tongue deflector  208  is positioned proximally of the tongue-contacting surface  207  of the pivoting portion  206  of the blade  202 . The tongue deflector  208  is configured to be rotatably mounted to the pivoting portion  206  of the blade  202  such that the tongue deflector  208  extends substantially along the length of the blade  202 . In a first, home position of the tongue deflector  208 , the edges of the tongue deflector  208  are abutted flush with the corresponding edges of the pivoting portion  206  of the blade. The tongue deflector  208  can rotate relative to pivoting portion  206  of the blade  202  to accomplish the tongue deflecting movement described herein for the other embodiments of the laryngoscope. 
         [0053]    In use, the blade  202  is inserted into the mouth of the patient until the distal end of the blade  202  is positioned at the junction between the base of the tongue and the base of the epiglottis. With one hand holding the handle  52  of the laryngoscope  200 , the user pivots the pivoting portion  206  of the blade  202  using the thumb or fingers of the other hand on the lever  62 . When the distal end of the pivoting portion  206  of the blade  202  is pivoted towards the handle  52  about the pivot point  203 , the tongue contacting surface  207  engages the tongue for elevating the tongue and exposing the larynx. The user may then rotate the lever  62  for pivoting the tongue deflector  208  using the thumb or fingers of the same hand. When the lever  62  is rotated relative to the blade  202 , the rod  86  and connected tongue deflector  208  are rotated about their rotation axis causing the tongue-contacting surface of the tongue deflector  208  to sweep the tongue and associated tissue to further expose the vocal cords and the larynx of a patient. 
         [0054]    Any one of the embodiments of the blade including the tongue deflector may be supplied as a sterile packaged, disposable item for single use. In an alternate embodiment, the blade would be constructed for repeated use and to resist degradation from repeated gas, chemical, or steam autoclave sterilization exposures. It is understood that the laryngoscope as described herein may comprise a range of handle or blade sizes and be suitable for use with adults, children or neonates, as well as being suitable for use in veterinary practice. 
         [0055]    The embodiments of the laryngoscope described and shown herein have many advantages, including requiring less force for positioning and movement of the blade as compared to a conventional laryngoscope. Facilitating this sweeping of the tongue is achieved by applying a rotary force to the tongue deflector for moving the comparatively tongue muscle mass. The tongue deflector allows a user to engage the tongue in a manner that is not possible using conventional laryngoscopes. In addition, the locking function of the laryngoscope maintains continued airway patency once established. 
         [0056]    As described above, the new blade can be used with conventional laryngoscope handles, which provide both ergonomic and power supply functions. Moreover, the tongue deflector can be made compatible for use on any type of laryngoscope blade known in the art, video scope blades, including Macintosh (curved) and Miller (straight) type blades which may be modified for the purposes and function as described herein. The laryngoscope is suitable for use by physicians, especially by anesthetists in procedures requiring the tracheal intubation of patients. The laryngoscope may also be used in veterinary practice. The tongue deflector may also be used with instruments other than a laryngoscope, such as an oral pharyngeal airway. 
         [0057]    Although the laryngoscope has been shown and described herein in considerable detail with respect to only a few exemplary embodiments thereof, it should be understood by those skilled in the art that I do not intend to limit the laryngoscope to the embodiments since various modifications, omissions and additions may be made to the disclosed embodiments without materially departing from the novel teachings and advantages of the laryngoscope, particularly in light of the foregoing teachings. Accordingly, I intend to cover all such modifications, omission, additions and equivalents as may be included within the spirit and scope of the laryngoscope as defined by the following claims. In the claims, means-plus-function clauses are intended to cover the structures described herein as performing the recited function and not only structural equivalents but also equivalent structures. Thus, although a nail and a screw may not be structural equivalents in that a nail employs a cylindrical surface to secure wooden parts together, whereas a screw employs a helical surface, in the environment of fastening wooden parts, a nail and a screw may be equivalent structures.