An oropharyngeal airway (OPA) is a medical device that is placed in the mouth and over the tongue to maintain an open airway in an unconscious victim. These devices are made up of a curved piece of semi-hard plastic with a hollow center and typically have a flange on one end. OPAs may also be known as Guedel pattern airways and come in a variety of sizes, as they must span a very specific area in the mouth and throat of the victim. While the application of the OPA may appear fairly direct and intuitive, improper placement or use of the wrong size has the potential to cause greater injury. These factors make training in the proper use of the oropharyngeal airway highly recommended by many sources.
When a person is unconscious, particularly if lying on the back, there is a risk that the tongue will relax and slide into the throat, obstructing it. In the field or at an accident scene, the oropharyngeal airway allows a person giving aid to move on to tending other injuries or even other victims once the airway is clear without having to worry as much about renewed obstruction. In a hospital, the OPA may be used to maintain a recently cleared airway while a more permanent device is prepared. In either case, the OPA is only necessary, and possibly even advisable, with an unconscious patient. A conscious patient will not likely have the tongue relax and obstruct the airway, and the presence of the OPA in a conscious patient may actually induce vomiting and create obstruction.
The oropharyngeal airway is inserted in one of two ways, with the preferred method employing a tongue depressor to hold the tongue down while the OPA is inserted into the throat. The key is to avoid shoving the tongue into the throat with the tip of the oropharyngeal airway, but, in less ideal situations, this can also be accomplished without a tongue depressor. Regardless the manner of insertion, the first step is determine the proper size of OPA. This is done by placing the OPA alongside the victim's jaw, with the flange lined-up with the opening of the mouth and the tip at the victim's ear. If the OPA is either significantly longer or shorter than the distance from the mouth opening to the ear, it may either fail to keep the airway open or create further obstruction.
In field conditions or at an accident scene, the mouth can be forced open along the back teeth with the thumb and index finger in a scissoring motion. With the flange end pointed toward the forehead, the oropharyngeal airway is then inserted with the other tip on the flat of the tongue and pointing toward the back of the mouth. The tip is then rotated upward to the roof of the mouth, using the curve as a fulcrum on the tongue so that it holds the tongue down. The OPA is then slid back along the tongue until the tip is past the back of the tongue — usually noticeable from the increase in resistance — spun 180° so that the tip points down the throat, and slid back again until the flange reaches the opening of the mouth.
A similar device, the nasopharyngeal airway (NPA), is much more narrow and made of flexible material such as rubber or latex. It is a less invasive device, so the NPA may be preferred over the OPA for conscious patients. The greater simplicity of insertion and reduced chance of injury from improper insertion make some institutions, such as militaries, prefer the NPA over the OPA in most situations.