Clinical Overview: The Mallampati Score
The Mallampati score is a cornerstone of preoperative airway assessment. It is used to predict the ease of endotracheal intubation by evaluating the relationship between the size of the tongue and the capacity of the oropharynx.
Procedure
The assessment is performed with the patient sitting upright, head in a neutral position, mouth opened maximally, and tongue protruded (without phonation/saying "Ahh").
The Four Classes
- Class I: Soft palate, uvula, fauces, and tonsillar pillars are all visible.
- Class II: Soft palate, fauces, and uvula are visible.
- Class III: Soft palate and base of uvula are visible.
- Class IV: Only the hard palate is visible.
Clinical Correlation
High Risk = Class III or IV
Where:
Class I/II=
Low risk of difficult airwayClass III/IV=
Increased risk of difficult intubationMallampati Classes III and IV are associated with a higher incidence of "difficult bag-mask ventilation" and "difficult laryngoscopy." While useful, it should never be used as the sole predictor of airway difficulty.