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Background: Early studies report on different calibers of the mesopharynx opening in the states of wakefulness and sedation. Objectives: Is it possible to manipulate the widening of the mesopharyngeal isthmus by particular maneuvers in the states of wakefulness and sedation? Methods: The mesopharyngeal isthmus of 50 healthy subjects was examined endoscopically in wakefulness and under sedation. The intraoral negative pressure was controlled by a vacuum activator. The following maneuvers were performed and widening of the isthmus was documented pictorially: spontaneous breathing with closed lips (SB), mandibular advancement (MA), tongue repositioning maneuver (TRM), and mandibular advancement combined with TRM (MA, TRM). While performing the tongue repositioning maneuver with closed lips, the tongue is adapted closely to the row of teeth and also to the hard and soft palate. Results: In wakefulness, 123 endoscopic pictures were analyzed, 35 with SB, 34 with MA, 35 with TRM, 19 with TRM and MA. In sedation there were 125 pictures, 35 with SB, 32 with MA, 34 with TRM, 24 with TRM and MA. The results represent that in sedation the TRM has a significant widening effect on the opening of the mesopharyngeal isthmus compared to SB without TRM ( p < 0.05). Compared to SB in sedation, the combined maneuver of TRM and MA had an additional effect on the widening of the mesopharyngeal isthmus ( p < 0.05). Conclusions: In sedation, the mesopharyngeal isthmus is stabilized by the TRM and the combined maneuver with MA and TRM because of the forward displacement of the tongue out of the pharynx with closed contact to the hard palate and apposition of the velum to dorsum of the tongue. [ABSTRACT FROM AUTHOR]