Clinical uses of the Bonfils Retromolar Intubation Fiberscope: a review.

The Bonfils Retromolar Intubation Fiberscope is a rigid, straight fiberoptic device with a 40-degree curved tip, which facilitates targeted intubation. Bonfils, using a retromolar approach to intubate tracheas of children with Pierre Robin syndrome, was first described in 1983. After an initial steep learning curve, the Bonfils becomes a useful device in the management of normal and difficult airways. The advantages lie in its performance as an optical intubating stylet, which allows visualization from the tip of the endotracheal tube during intubation. The slim profile makes it useful in patients with limited mouth opening and cervical spine movement. Unlike the flexible fiberoptic bronchoscope, its rigid structure improves maneuverability and allows insertion past soft tissue obstructions. Endoscopic orientation of the Bonfils is better than the flexible fiberoptic bronchoscope, and it is also portable, durable, and simple to set up. The main difficulty experienced by Bonfils users is common to all fiberoptic scopes, limited view due to blood, secretions, fogging, and tissue contact. Additionally, nasal intubation is not possible with the Bonfils, and direct trauma and barotrauma are possible. Although the intubation success rate is high, it is still very much operator dependent. Time to intubation is inferior to conventional laryngoscopy, and its expense may be an issue in some centers. In conclusion, the Bonfils is an effective tool for management of the difficult airway after initial training.