Mallampati Classification 

Updated: Mar 21, 2014
  • Author: James J Lamberg, DO; Chief Editor: Meda Raghavendra (Raghu), MD  more...
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Mallampati Classification

Modified Mallampati classification

See the list below:

  • Class 0: Ability to see any part of the epiglottis upon mouth opening and tongue protrusion
  • Class I: Soft palate, fauces, uvula, pillars visible
  • Class II: Soft palate, fauces, uvula visible
  • Class III: Soft palate, base of uvula visible
  • Class IV: Soft palate not visible at all

The assessment is performed with the patient sitting up straight, mouth open and tongue maximally protruded, without speaking or saying “ahh.” [1, 2, 3, 4, 5]

Predictive value of modified Mallampati classification

See the list below:

  • Difficult laryngoscopy: Good accuracy (area under summary receiver operating characteristic [SROC] curve 0.89 ± 0.05)
  • Difficult intubation: Good accuracy (area under sROC curve 0.83 ± 0.03)
  • Difficult mask ventilation: Poor predictor
  • Used alone, the Mallampati tests have limited accuracy for predicting the difficult airway and thus are not useful screening tests
  • Mallampati classification is only one of 11 nonreassuring findings during airway examination

Nonreassuring findings during airway physical examination

See the list below:

  • Relatively long upper incisors
  • Prominent “overbite” (maxillary incisors anterior to mandibular incisors)
  • Patient cannot bring mandibular incisors anterior to (in front of) maxillary incisors
  • Interincisor distance less than 3 cm
  • Uvula not visible when tongue is protruded with patient in sitting position (eg, Mallampati class >II)
  • Palate highly arched or very narrow
  • Mandibular space stiff, indurated, occupied by mass, or nonresilient
  • Thyromental distance less than 3 ordinary finger breadths
  • Short neck length
  • Thick neck circumference
  • Patient cannot touch tip of chin to chest or cannot extend neck