Classification
Mallampati score
Also known as: Mallampati classification, modified Mallampati score
The Mallampati score grades how much of the oropharynx is visible when a seated patient opens their mouth and protrudes the tongue, on a four-class scale. Higher classes suggest a potentially more difficult intubation. It is one input to airway assessment rather than a test in itself, and is always read alongside other airway findings.
- Assesses
- Visibility of oropharyngeal structures on mouth opening
- Classes
- I to IV
- Direction
- Higher class suggests a potentially more difficult airway
- Limitation
- Modest predictive value alone; always combined with other airway findings
The four classes
Assessed with the patient seated, mouth open and tongue protruded:
| Class | What is visible |
|---|---|
| I | Soft palate, fauces, uvula and tonsillar pillars |
| II | Soft palate, fauces and uvula |
| III | Soft palate and base of the uvula |
| IV | Soft palate not visible |
Why it is never used alone
A high Mallampati class raises the index of suspicion; it does not predict a difficult airway reliably by itself. It is read together with the rest of the airway history — previous difficult intubation, mouth opening, neck movement, dentition, and body habitus — and it is the combination that changes a plan.
This is the general shape of perioperative risk assessment, and the reason screening on single scores in isolation tends to disappoint. The value of any one measure is that it contributes to a profile.
In a remote assessment
Mallampati grading requires someone to look, so it is not something a voice interview can score. What structured pre-operative interviewing contributes is everything around it: previous anaesthetic difficulties, family history of anaesthetic problems, dentition, and the other airway history that determines whether a physical airway assessment needs to happen early rather than on the day. Airway assessment is one of the twelve domains the interview covers for exactly that reason.