We read with interest the letters on the visible epiglottis (1,2). We treated a 10-yr-old girl with cervical hemivertebrae fused in extension. She also had a short, webbed, neck which was extended, and mobility was restricted to the atlanto occipital joint. She was to undergo neck web release and scapuloplasty. Her airway was anticipated to be difficult. On examination, she had a visible epiglottis (Figs. 1 and 2). On laryngoscopy, visualization was adequate (Cormack and Lehane Grade II), and intubation was easy.Figure 1: Child with the visible epiglottis.Figure 2: Lateral radiograph of neck of the same patient showing the tip of the epiglottis lying opposite C2 vertebra and the abnormally fused vertebral bodies.Subsequent to this case, we looked for a visible epiglottis in 100 consecutive patients, ages 6–10 yr, presenting for routine preanesthetic check. We found a visible epiglottis in six, much more frequent than the 1% incidence Maleck et al. (2) have reported. This may be because the Mallampatti sign is not examined routinely in the pediatric population as it is difficult to assess, and if elicited, may not be very predictive of a difficult airway (3). In our patients who had a visible epiglottis, the level of the epiglottis was no higher in the lateral radiograph than in those whose epiglottis was not visible, implying that the epiglottis was visible because the size of the tongue was small relative to that of the pharynx, a favorable grade on the Mallampati classification (4). The infant larynx is located at C3, with the tip of the epiglottis lying at C2 (5). Despite being located higher than in adults, it is not commonly visible in infants and small children because the entire tongue is placed intraorally and obstructs the epiglottis from view. As the child grows, the larynx descends down to C4 in childhood and further to the adult position of C5-6. However, the epiglottis does not undergo a similar descent, with the tip located at around the C2-3 level (5). However, with the descent of the larynx, part of the tongue becomes pharyngeal, resulting in less obstruction to the epiglottis, especially in children of age 6–10 yr. Sreekrishna Raghavendran MD, DNB Lakshmi Vas DA, MD