What is the Mallampati (Friedman classification) score?

From the Guidelines

The Mallampati score is a clinical assessment tool used to predict the difficulty of endotracheal intubation by evaluating the visibility of oropharyngeal structures, ranging from Class I to IV, with higher scores indicating potentially difficult intubation. This assessment is performed by having the patient sit upright, open their mouth as wide as possible, and protrude their tongue without phonation. The score is as follows:

• Class I shows full visibility of tonsils, uvula, and soft palate
• Class II shows visibility of hard and soft palate, upper portion of tonsils and uvula
• Class III shows only the soft and hard palate and base of uvula
• Class IV shows only the hard palate. The Mallampati score is a useful tool in predicting difficult intubation, especially when combined with other airway assessment parameters like thyromental distance, neck mobility, and body mass index, as noted in studies such as 1. The anatomical basis for this correlation is that limited visibility of posterior pharyngeal structures often indicates a more challenging glottic visualization during laryngoscopy.

Some key points to consider when using the Mallampati score include:

• It should be performed during pre-anesthetic evaluation to anticipate airway challenges and prepare appropriate equipment and assistance if needed
• The score's predictive value increases when combined with other airway assessment parameters
• Higher scores (III and IV) indicate potentially difficult intubation, and therefore require more careful planning and preparation. As noted in 1, the Mallampati score is one of the factors used in the MACOCHA score, which is a predictive score for difficult intubation in intensive care units.

In clinical practice, the Mallampati score is an essential tool for anesthesiologists and other healthcare professionals to assess the airway and predict potential difficulties with intubation, as highlighted in 1. By using the Mallampati score in conjunction with other assessment parameters, healthcare professionals can better prepare for potential airway challenges and provide optimal care for their patients.

It is also worth noting that the Mallampati score has been used in various clinical settings, including intensive care units and operating rooms, as discussed in 1. The score has been shown to be a useful tool in predicting difficult intubation and guiding airway management decisions.

Overall, the Mallampati score is a valuable tool in clinical practice, and its use can help improve patient outcomes by anticipating and preparing for potential airway challenges.

From the Research

Mallampati Score Overview

• The Mallampati score is a critical assessment criterion used to evaluate the difficulty of tracheal intubation 2.
• It is widely used in combination with other measures to assess the difficulty of tracheal intubation 2, 3.
• The score is used to predict difficult laryngoscopy and intubation, which can lead to severe complications and even death if not properly managed 3, 4.

Classification and Prediction

• The Mallampati classification is used to predict difficult tracheal intubation, with higher scores indicating a higher risk of difficulty 3, 5.
• The modified Mallampati classification score is part of the preoperative airway risk assessment and is used to predict difficult orotracheal intubation 5.
• The best visible Mallampati score has been proposed as an alternative to the modified Mallampati classification score, but its diagnostic characteristics are still unknown 5.
• Studies have shown that the Mallampati classification is related to the ease of seating of the laryngeal mask airway (LMA) in adults 6.

Diagnostic Characteristics

• The sensitivity and specificity of the modified Mallampati classification score for predicting difficult orotracheal intubation have been reported to be 0.56 and 0.69, respectively 5.
• The best visible Mallampati score has been shown to be less sensitive but more specific than the modified Mallampati classification score for predicting difficult orotracheal intubation 5.
• The Mallampati classification has been shown to have a high receiver operating characteristic (ROC) and area under the curve (AUC) for predicting difficult laryngoscopy, with a sensitivity of 86.7% 4.