In
anesthesia
Anesthesia is a state of controlled, temporary loss of sensation or awareness that is induced for medical or veterinary purposes. It may include some or all of analgesia (relief from or prevention of pain), paralysis (muscle relaxation), ...
, the Mallampati score or Mallampati classification, named after the Indian
anaesthesiologist
Anesthesiology, anaesthesiology, or anaesthesia is the medical specialty concerned with the total perioperative care of patients before, during and after surgery. It encompasses anesthesia, intensive care medicine, critical emergency medicine, ...
Seshagiri Mallampati, is used to predict the ease of
endotracheal intubation
Tracheal intubation, usually simply referred to as intubation, is the placement of a flexible plastic tube into the trachea (windpipe) to maintain an open airway or to serve as a conduit through which to administer certain drugs. It is frequently ...
.
The test comprises a visual assessment of the distance from the tongue base to the roof of the mouth, and therefore the amount of space in which there is to work. It is an indirect way of assessing how difficult an intubation will be; this is more definitively scored using the
Cormack-Lehane classification system, which describes what is actually seen using direct
laryngoscopy
Laryngoscopy () is endoscopy of the larynx, a part of the throat. It is a medical procedure that is used to obtain a view, for example, of the vocal folds and the glottis. Laryngoscopy may be performed to facilitate tracheal intubation during ge ...
during the intubation process itself. A high Mallampati score (class 3 or 4) is associated with more difficult intubation as well as a higher incidence of
sleep apnea
Sleep apnea, also spelled sleep apnoea, is a sleep disorder in which pauses in breathing or periods of shallow breathing during sleep occur more often than normal. Each pause can last for a few seconds to a few minutes and they happen many times ...
.
Technique
The score is assessed by asking the patient, in a sitting posture, to open their mouth and to protrude the tongue as much as possible.
The
anatomy
Anatomy () is the branch of biology concerned with the study of the structure of organisms and their parts. Anatomy is a branch of natural science that deals with the structural organization of living things. It is an old science, having its ...
of the
oral cavity
In animal anatomy, the mouth, also known as the oral cavity, or in Latin cavum oris, is the opening through which many animals take in food and issue vocal sounds. It is also the cavity lying at the upper end of the alimentary canal, bounded on ...
is visualized; specifically, the assessor notes whether the base of the
uvula
The palatine uvula, usually referred to as simply the uvula, is a conic projection from the back edge of the middle of the soft palate, composed of connective tissue containing a number of racemose glands, and some muscular fibers. It also conta ...
,
faucial pillars
The fauces, isthmus of fauces, or the oropharyngeal isthmus, is the opening at the back of the mouth into the throat. It is a narrow passage between the velum and the base of the tongue.
The fauces is a part of the oropharynx directly behind the ...
(the arches in front of and behind the tonsils) and
soft palate
The soft palate (also known as the velum, palatal velum, or muscular palate) is, in mammals, the soft tissue constituting the back of the roof of the mouth. The soft palate is part of the palate of the mouth; the other part is the hard palate. ...
are visible. Scoring is generally done without
phonation
The term phonation has slightly different meanings depending on the subfield of phonetics. Among some phoneticians, ''phonation'' is the process by which the vocal folds produce certain sounds through quasi-periodic vibration. This is the defini ...
. Depending on whether the tongue is maximally protruded and/or the patient asked to phonate, the scoring may vary.
Modified Mallampati Scoring:
* Class I: Soft palate, uvula, fauces, pillars visible.
* Class II: Soft palate, major part of uvula, fauces visible.
* Class III: Soft palate, base of uvula visible.
* Class IV: Only hard palate visible.
Original Mallampati Scoring:
* Class 1: Faucial pillars, soft palate and uvula could be visualized.
* Class 2: Faucial pillars and soft palate could be visualized, but uvula was masked by the base of the tongue.
* Class 3: Only soft palate visualized.
Further research may be needed to determine the most effective consistent and predictive approach on which to standardize Mallampati Scoring.
Clinical significance
While Mallampati classes I and II are associated with relatively easy intubation, classes III and IV are associated with increased difficulty.
A systematic review of 42 studies, with 34,513 participants, found that the modified Mallampati score is a good predictor of difficult direct laryngoscopy and intubation, but poor at predicting difficult bag mask ventilation.
Therefore, the study concluded that while useful in combination with other tests to predict the difficulty of an airway, it is not sufficiently accurate alone.
See also
*
Cormack-Lehane classification system
*
Simplified Airway Risk Index
The Simplified Airway Risk Index (SARI), or El-Ganzouri Risk Index (EGRI), is a multivariate risk score for predicting difficult tracheal intubation.
The SARI score ranges from 0 to 12 points, where a higher number of points indicates a more diffi ...
*
Thyromental distance Thyromental distance (TMD) measurement is a method commonly used to predict the difficulty of Tracheal intubation, intubation and is measured from the Superior thyroid notch, thyroid notch to the tip of the jaw with the head extended. If it is less ...
References
External links
Mallampati score- fpnotebook.com
{{Anesthesia
Anesthesia
Medical scoring system