Where is the tip of the Macintosh laryngoscope blade placed during direct laryngoscopy in intubation?

• A. Arytenoid prominence
• B. Subglottic fold
• C. Vallecula
• D. Esophagus

Answer: (C)

Placing the tip of the Macintosh blade in the vallecula is the intended maneuver because it allows indirect lifting of the epiglottis. The vallecula is the space between the base of the tongue and the epiglottis; when the blade is seated there and you lift upward, the epiglottis is pulled forward, revealing the glottic opening for tube placement. This approach provides a clear view with less force on the delicate vocal structures.

Putting the blade tip at the arytenoid prominence would push directly on the arytenoids and tend to obscure the view or cause trauma; it’s not how the Macintosh blade is used. The subglottic fold isn’t the landmark targeted during this maneuver, and the esophagus is the wrong destination entirely, since the goal is to visualize and access the airway, not the stomach. Vallecula is the correct site because it optimizes exposure of the vocal cords with controlled lifting.