Mallampati Classification

Modified Mallampi classes are as follows^{[1, 2, 3]}:

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.”

The predictive value of modified Mallampati classification is as follows^{[1, 4, 5, 6]}:

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 overall, but class III-IV can suggest difficulty with mask ventilation
Used alone, the Mallampati tests have limited accuracy for predicting the difficult airway and thus are not useful screening tests.
Interobserver variability, measured by intraclass correlation coefficients, is well documented for the Mallampati classification.
Mallampati classification is only one of 11 nonreassuring findings during airway examination.

Nonreassuring findings during airway physical examination include the following^{[1, 7]}:

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