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Case Reports in Anesthesiology
Volume 2012 (2012), Article ID 297306, 3 pages
Case Report

Use of the Bonfils Intubation Fiberscope in Patients with Limited Mouth Opening

1Anesthesia Department, HMC-Weill Cornell Medical College, P.O. Box 24144, Doha, Qatar
2Anaesthesia and Intensive Care Section, Department of Emergency, G.B. Morgagni-Pierantoni Hospital, viale Forlanini 34, 47100 Forlì, Italy

Received 6 June 2012; Accepted 2 August 2012

Academic Editors: S. Faenza and E. W. Nielsen

Copyright © 2012 Nabil A. Shollik et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Airway management of patients with very limited mouth opening remains a challenge for the anaesthetist. We describe the use of the Bonfils Intubation Fiberscope for awake intubation in two patients with a very limited mouth opening. In the first case, a 60-year-old 80 kg female, scheduled for a right modified radical mastectomy for infiltrating ductal carcinoma (15 mm mouth opening, a short thick neck, limited neck extension, and a Mallampati class 4 airway), the Bonfils was advanced via the retromolar technique. In the second patient, a 34-year-old male, scheduled for a surgical tracheotomy for right tonsillar cancer, due to a neoplastic infiltration of the right temporomandibular joint (7 mm mouth opening and limited neck movement), the Bonfils was advanced using the midline approach. The Bonfils is a reusable, rigid, straight fiberoptic device with a curved tip, is 5 mm in diameter, and has several advantages: it is quick and easy to use, more cost effective than a flexible fiberscope, and is safe in expert hands, thanks to its smaller diameter. Our conclusion is that awake BIF intubation is a reliable, atraumatic, and well-tolerated procedure to secure a safe airway in patients with a limited mouth opening.