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What Is the Mallampati Score?

By W. Joyner
Updated Mar 03, 2024
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The Mallampati score, also referred to as the Mallampati classification, is a medical scoring system used in anesthesiology to determine the potential level of difficulty, and subsequent risk, in intubating a patient undergoing surgery. The score determines a rating for the patient, ranging from Class I to Class IV. A Class I rating indicates a patient who should prove relatively easy to intubate. The highest rating, Class IV, is assigned to patients with a higher risk of complications.

Intubation is necessary during anesthesia in order to provide a means of breathing artificially while the patient is anesthetized and unable to breathe on his or her own. During intubation, a tube is inserted through the throat into the airways. The tube can then be connected to either a mask or an artificial ventilator in order to provide the patient with oxygen during the procedure.

Mallampati classification is determined by visual observation of the oral cavity. The test to establish the Mallampati score is performed with the patient in an upright sitting posture, with the head held in a neutral position. As the patient holds his or her mouth open wide and extends the tongue, the technician checks for clear visibility of pharyngeal structures.

A Class I Mallampati score is given if the soft palate, tonsils, anterior and posterior pillars, and the entire uvula — the piece of soft tissue that hangs down from the roof of the mouth near the back of the tongue — are easily visible. A Class II score is given if the soft palate, tonsils, and most of the uvula can be seen. In cases where only the soft palate and the base of the uvula are visible, the patient is assigned a Class III rating. A Class IV Mallampati score is reserved for those instances where no soft palate is visible at all. Patients who have a Class III or Class IV result are likely to be difficult to intubate, and other preparations should be made for alternative airway management, such as use of a bag mask respirator.

Gauging the potential difficulty of intubation with a patient is an important step in the anesthesia process. The Mallampati score is often used in conjunction with other tests, such as the thyromental distance, a measurement extending from the highest point of the thyroid cartilage to the chin. Measuring the neck extension at the atlanto-occipital joint, the point where the skull adjoins to the spine, is also useful. Considering the Mallampati results in combination with additional evaluations results in a more comprehensive assessment and serves to enhance the safety of the patient.

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