From the Guidelines
In a patient with a Mallampati Class IV airway, no oropharyngeal structures are visible during examination, with only the hard palate being visible when the patient opens their mouth and protrudes their tongue without phonation. The soft palate, uvula, faucial pillars, and posterior pharyngeal wall are completely obscured from view, as indicated by the Mallampati classification system, which emphasizes the importance of the base of the tongue in predicting difficulty with laryngoscopy 1. This classification is crucial for clinicians to predict difficult airways before procedures requiring intubation. Key points to consider in a Mallampati Class IV airway include:
- Limited visualization of oropharyngeal structures, which may complicate laryngoscopy
- Potential for difficult airway intubation, necessitating advanced airway management techniques or equipment
- Importance of preparing alternative airway management strategies to ensure patient safety during procedures requiring airway management. The Mallampati score is used to predict difficult intubation, and a Class IV airway often correlates with challenging intubation conditions 1.
From the Research
Oropharyngeal Structures in Mallampati Class IV Airway
In a patient with a Mallampati Class IV airway, the following oropharyngeal structures are visible:
- Soft palate is not visible 2
Comparison with Other Mallampati Classes
The visibility of oropharyngeal structures in Mallampati Class IV airway is limited compared to other classes:
- Class I: soft palate, fauces, uvula, palatopharyngeal arch visible
- Class II: soft palate, fauces, uvula visible
- Class III: soft palate, base of the uvula visible
- Class IV: soft palate not visible 2
Clinical Implications
Patients with Mallampati Class IV airway are at increased risk of difficult intubation and airway injury: