BACKGROUND: Head extension and excessive laryngoscope blade levering motion (LBLM) are undesirable during airway management of trauma patients. We hypothesized that laryngoscopy with a modified blade facilitating glottic exposure by balloon inflation would reduce head extension and LBLM. PATIENTS AND METHODS: Seventeen elective surgery patients were enrolled. Patients lay supine with their heads flat on a rigid board and had a rigid collar around their necks. Laryngoscopy was performed with the modified blade and a standard curved blade. Head extension and LBLM angles were determined upon maximal glottic exposure and compared used paired t-tests. Laryngoscopic view grade and oxygen saturation were also determined. RESULTS: Balloon laryngoscopy resulted in less head extension and LBLM (P <0.001). Laryngoscopic view was approximately identical with both blades, and oxygen saturation was always above 97%. CONCLUSIONS: Balloon laryngoscopy reduces head extension and LBLM under simulated cervical spine precautions.