The Magill forceps is a standard instrument on every anesthesia airway cart, yet it is often not deeply understood by the people ordering it. It is also one of the instruments most commonly ordered in the wrong size — which limits its function in the two clinical situations where it is actually needed.
What Is the Magill Forceps?
The Magill forceps is a ring-handled angled forceps with an upward-curved shaft and oval-ringed jaws designed for grasping within the oropharynx. It was designed by Sir Ivan Magill in the 1920s alongside the development of oral tracheal intubation, and its geometry has not changed materially since — the design works for the anatomy it was built for.
The angled shaft keeps the surgeon’s hand out of the line of sight during intubation and allows the jaws to reach the oropharynx and glottis from a standard head position. The ring jaws are non-crushing — they grip without lacerating delicate pharyngeal mucosa or damaging an endotracheal tube cuff.
Clinical Uses
Nasotracheal Intubation
The primary use of the Magill forceps is directing the tip of a nasal endotracheal tube through the glottis during nasotracheal intubation. The tube is advanced nasally until its tip is visible in the oropharynx under direct laryngoscopy; the Magill forceps grasps the tube tip and steers it toward the open glottis while an assistant advances the tube from the nasal end. This technique is used in oral and maxillofacial surgery, some ENT procedures, and in patients where an oral tube is contraindicated.
Foreign Body Removal
The Magill forceps is used to remove pharyngeal and laryngeal foreign bodies in both emergency and elective settings. The non-crushing ring jaws provide grip without fragmenting soft foreign bodies (food bolus, bone fragments) that crush jaws would split into multiple smaller pieces. For this use, the largest available size provides the most reliable grip on objects of variable diameter.
Throat Pack Placement
During oral and maxillofacial surgical procedures performed under general anesthesia, a throat pack is placed in the oropharynx to prevent blood and debris from passing into the trachea around the cuffed tube. The Magill forceps is used to position and retrieve the throat pack with controlled placement at the glottic level.
Sizes — Choosing the Right One
Magill forceps are available in three standard sizes:
- Small (child, 16 cm) — for patients under 8 years; smaller jaw diameter and shorter shaft for the pediatric oropharynx
- Medium (large child/small adult, 20 cm) — for patients 8 to 12 years; transitional size
- Large (adult, 25 cm) — standard adult size; the most commonly ordered; shaft length accommodates the full adult oral and oropharyngeal depth
The most common ordering error is purchasing only the adult size for a mixed adult-pediatric airway cart. Pediatric Magill forceps are sized for smaller airways — using an adult Magill on a child occupies too much of the oral cavity to allow adequate laryngoscopy view and tube control simultaneously.
Material and Design Features
Fizza Surgical Magill forceps are manufactured from 316L stainless steel throughout — shaft, rings, and jaw mechanism. The oval jaw rings are smooth-finished on the outer surface to prevent pharyngeal mucosal abrasion during use. Ring handle diameter accommodates double-gloved hands (28 mm internal diameter). Compatible with steam autoclave at 134 degrees Celsius.
2026 Update: Size Selection and Care Notes
Two questions come up repeatedly from procurement teams building or restocking an airway cart, so this section addresses both directly.
Size Selection at a Glance
| Size | Length | Patient range | Primary indication |
|---|---|---|---|
| Small (child) | 16 cm | Under 8 years | Paediatric nasotracheal intubation, small foreign bodies |
| Medium | 20 cm | 8–12 years | Transitional airways, adolescent nasal tubes |
| Large (adult) | 25 cm | Adult | Adult nasotracheal intubation, throat packs, food bolus retrieval |
A mixed adult and paediatric cart needs all three. A theatre suite handling adults only can reasonably stock the 25 cm alone, but should still carry a spare — a Magill forceps dropped mid-intubation cannot be substituted from the general tray, because no other instrument on it has both the angle and the non-crushing ring jaw.
Care Points Specific to Ring-Jaw Instruments
The ring jaws and the box joint are what fail, and both fail quietly.
- Check jaw alignment before every pack. Close the forceps and look at the two oval rings from the side. They should meet face to face across their full circumference. A lateral offset of even half a millimetre means the instrument will slide off a tube tip under load.
- Inspect the outer ring surface for burrs. These instruments contact pharyngeal mucosa directly. A burr raised by contact with a heavier instrument in a wash basket becomes a mucosal laceration.
- Lubricate the joint with a water-soluble instrument milk after every reprocessing cycle, never an oil-based product, which blocks steam contact. See our guide on surgical instrument lubrication for the reasoning.
- Process separately from heavy instruments. Magill forceps in a basket underneath retractors and bone clamps is the most common cause of jaw distortion in service.
- Steam sterilise at 134 °C for 3 minutes, joint open, jaws not under tension.
For the wider airway trolley, our difficult airway cart setup guide covers how the Magill forceps sits alongside laryngoscopes, bougies, and supraglottic devices in a structured layout.
Frequently Asked Questions
Why are Magill forceps angled rather than straight?
The upward curve of the shaft keeps the operator’s hand and wrist below the line of sight during direct laryngoscopy. A straight forceps of the same length would block the view of the glottis at exactly the moment the tube tip needs steering.
Can Magill forceps be used to remove an airway foreign body in an emergency?
Yes, and it is a standard indication. The non-crushing oval ring jaws grip a food bolus or bone fragment without splitting it into smaller pieces that would migrate further down. Use the largest size available, since a wider jaw span grips objects of variable diameter more reliably.
Will Magill forceps damage an endotracheal tube cuff?
Not if used correctly. The ring jaws are deliberately non-crushing and the grip is applied to the tube shaft proximal to the cuff, never across the cuff itself. Grasping the cuff directly risks a puncture that will not be apparent until after intubation.
What material should Magill forceps be made from?
316L austenitic stainless steel is preferred over martensitic grades for this instrument, because it offers superior corrosion resistance in an environment of repeated exposure to saliva and blood, and the instrument does not need a hardened cutting edge.
How many should an anaesthetic department stock?
At minimum, one of each size per airway cart, plus a spare adult size per theatre suite. Departments running regular maxillofacial or ENT lists where nasotracheal intubation is routine typically hold two adult forceps per theatre so that one is always available while the other is being reprocessed.
All instruments are manufactured under ISO 13485:2016 with CE marking. Available individually by size or as a complete three-size set for airway carts and anesthesia trolleys. Contact Fizza Surgical for pricing or to request instruments for evaluation.
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