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    Attention COACH STUDY participants:

    The principal investigators of the study request that you use the official version of the modified score here.

    Modified Mallampati Classification

    Stratifies predicted difficulty of endotracheal intubation based on anatomic features.

    INSTRUCTIONS

    Position patient seated upright and direct patient to open mouth and protrude tongue fully.

    When to Use
    Pearls/Pitfalls
    Why Use

    Patients requiring endotracheal intubation.

    • The original Mallampati Classification had three classes of visualization, but a fourth was later added by Samsoon and Young (1987) and shown to have greater predictive value, and is the version most commonly used today. 
    • While the Mallampati Classification is usually determined with the patient sitting up, a recent prospective cohort study suggests that evaluating the patient supine may better predict difficult intubation (AUC 0.82 supine over 0.7 while sitting, Hanouz 2018).
    • A class 0 has been proposed by Ezri et al (1998) to denote “extremely easy” intubation, but evidence supporting its accuracy is limited to case reports.
    • A low score may predict easy laryngoscopy and intubation, but it does not guarantee it. While a high score should prompt caution, a low score is not intended to provide reassurance.

    Simple to use at the bedside, can be performed in less than a minute, and has good accuracy (AUC 0.83, Lee 2006) at predicting difficult airway (difficult laryngoscopy, difficult intubation, or difficult ventilation).

    Faucial pillars, soft palate, and uvula visualized
    Faucial pillars and soft palate visualized, but uvula masked by tongue base
    Only soft palate visualized
    Soft palate not visualized

    Result:

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    Next Steps
    Evidence
    Creator Insights
    Dr. Seshagiri R. Mallampati

    About the Creator

    Seshagiri R. Mallampati, MD, is a retired anesthesiologist. He practiced at Brigham and Women's Hospital throughout his clinical career. Dr. Mallampati is perhaps best known for his eponymous airway scoring system.

    To view Dr. Seshagiri R. Mallampati's publications, visit PubMed

    Are you Dr. Seshagiri R. Mallampati? Send us a message to review your photo and bio, and find out how to submit Creator Insights!
    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
    Content Contributors
    About the Creator
    Dr. Seshagiri R. Mallampati
    Are you Dr. Seshagiri R. Mallampati?
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