Mallampati Airway Classification

The Mallampati score was developed by Seshagiri Mallampati, an American anesthesiologist, in 1985 as a non-invasive way to assess the airway. It is a visual examination that compares the size of the tongue to the size of the oral cavity.

To perform a Mallampati classification, the patient should be in the seated position with a neutral head, open mouth, and tongue protruded as much as possible. It is preferably done without phonation.

There are 4 classes:

Class 1: the entire palatal arch, soft palate, uvula, and pillars are visible

Class 2: upper part of the pillars and most of the uvula are visible

Class 3: soft palate, base of uvula, and hard palate are visible

Class 4: only hard palate is visible

The Mallampati classification should be part of an airway exam prior to any procedure. Mallampati class 3 or 4 can be suggestive of a difficult airway; however, independently it is a poor predictor of difficult airway. Mallampati classes 3 or 4 are also associated with higher incidence of sleep apnea.

A systematic review in 2006 which consisted of 34,513 adult patients showed that Mallampati score is a good predictor of difficult direct laryngoscopy and intubation but poor predictor of difficult bag mask ventilation. The same study also showed that Mallampati score is even more accurate at predicting a difficult laryngoscopy in obstetric patients compared to non-obstetric patients.