A 52-year-old man with a history of type 2 diabetes and hypertension presents to the pre-anesthetic clinic for elective laparoscopic cholecystectomy. On airway assessment, when he opens his mouth fully and protrudes his tongue, the soft palate and fauces are visible, but the base of the uvula is not seen. His neck mobility is normal, thyromental distance is 6.5 cm, and interincisor gap is 4 cm. What is his Mallampati score?

## Mallampati Classification Overview The Mallampati score is a simple bedside test used to predict the ease of intubation by assessing the visibility of pharyngeal structures when the patient opens the mouth fully with the tongue protruded. ### Mallampati Grading System | Class | Structures Visible | Difficulty | Incidence (%) | |-------|-------------------|------------|---------------| | I | Soft palate, fauces, uvula, anterior and posterior pillars | Easy | 80 | | II | Soft palate, fauces, uvula | Easy–Moderate | 15 | | III | Soft palate, base of uvula | Moderate–Difficult | 4 | | IV | Only hard palate visible | Difficult | 1 | **Key Point:** In this patient, the soft palate and fauces are visible, but the base of the uvula is NOT seen — this is the hallmark of **Mallampati Class III**. **High-Yield:** Mallampati Class III and IV are associated with difficult intubation. A Class III airway has a 6–15% incidence of difficult intubation, while Class IV has a 50% incidence. **Clinical Pearl:** Mallampati score alone is not 100% sensitive or specific for predicting difficult airway. It must be combined with other parameters: - Thyromental distance (>6 cm = easy, <6 cm = difficult) - Interincisor gap (>3 cm = easy) - Neck mobility (full range = easy) - Body mass index (>30 = higher risk) In this case, despite Class III Mallampati, the patient has favorable thyromental distance (6.5 cm), normal interincisor gap (4 cm), and normal neck mobility — suggesting an overall **moderate airway** rather than a truly difficult one. **Mnemonic:** **LEMON** assessment for difficult airway: - **L**ook externally (facial anatomy, body habitus) - **E**valuate the 3-3-2 rule (interincisor gap ≥3 fingers, thyromental distance ≥3 fingers, hyoid-to-thyroid distance ≥2 fingers) - **M**allampati score - **O**pen mouth (interincisor gap) - **N**eck mobility **Tip:** Always document Mallampati score with the patient in a sitting position, mouth fully open, tongue maximally protruded, without phonation. The examiner should view from the patient's eye level.