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    Chief Complaint


    Organ System


    Patent Pending

    Modified Mallampati Classification

    Stratifies predicted difficulty of endotracheal intubation based on anatomic features.


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

    When to Use
    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


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    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

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