Mallampati Classification Overview
The Mallampati score is a simple, non-invasive bedside test for predicting difficult intubation based on the extent of pharyngeal structures visible with the mouth wide open and tongue protruded.
Mallampati Classes — Comparison Table
| Class | Structures Visible | Difficulty Prediction | Clinical Significance |
|---|
| I | Soft palate, fauces, uvula, anterior tonsillar pillars | Easy intubation | Low risk |
| II | Soft palate, fauces, uvula (partial) | Easy to moderate | Low-moderate risk |
| III | Soft palate only; hard palate and uvula obscured | Moderate to difficult | Moderate-high risk |
| IV | Hard palate only; soft palate not visible | Difficult intubation | High risk |
Key Point
Class III is the critical discriminator — the soft palate is visible but the uvula and fauces are obscured by the base of the tongue, indicating reduced pharyngeal space.
Why Class III Matters
High-YieldNEET PG
Mallampati Class III and IV correlate with difficult laryngoscopy and increased risk of failed intubation. Class III represents the threshold where airway management becomes challenging.
Clinical Pearl
In routine preoperative screening, Mallampati Class III patients warrant additional airway assessment (thyromental distance, neck mobility, inter-incisor gap) and may benefit from awake fiberoptic intubation or regional anesthesia when feasible.
Examination Technique
- 1.
Patient sits upright
- 2.
Mouth opened maximally
- 3.
Tongue protruded fully without phonation
- 4.
Observer views from eye level at patient's mouth
- 5.
Lighting must be adequate
Warning
Mallampati score alone is insufficient for airway assessment — it must be combined with other parameters (thyromental distance ≥6 cm, inter-incisor gap ≥3 cm, cervical spine mobility, dentition, facial anatomy).
