Airway Assessment — Mallampati

A 48-year-old woman with a BMI of 34 kg/m² and a history of obstructive sleep apnea presents for pre-anesthetic evaluation before open abdominal hysterectomy. On airway examination, the patient is positioned upright, asked to open her mouth maximally and protrude her tongue. The examiner observes that the soft palate and uvula are visible, but the anterior and posterior tonsillar pillars are obscured by the lateral pharyngeal walls. The patient also has a thyromental distance of 5.5 cm, neck circumference of 42 cm, and limited neck extension due to cervical spondylosis. What is the Mallampati grade, and what is the most appropriate next step in airway management?

A 48-year-old woman with a BMI of 34 kg/m² and a short neck is undergoing pre-anesthetic evaluation for thyroid surgery. On Mallampati assessment, she cannot visualize the uvula or soft palate—only the hard palate is visible. She has full neck mobility and no other airway pathology. What is the most appropriate next step?

A 52-year-old male patient with a history of rheumatoid arthritis presents for elective knee arthroplasty. On pre-anesthetic evaluation, clinical examination reveals limited mouth opening (25 mm) and a Mallampati score of Grade 3. Which investigation is most appropriate to further assess the airway and predict difficulty with intubation?

A 38-year-old female patient with a history of acromegaly presents for transsphenoidal pituitary surgery. Pre-operative airway assessment shows a Mallampati score of Grade 4 with a normal thyromental distance (6.5 cm). Which investigation is most useful to confirm the anatomical basis of the difficult airway and guide anesthetic management?

During pre-anesthetic evaluation, the anesthesiologist assesses multiple patients using the Mallampati grading system. Among patients with Mallampati Grade III or IV (difficult airway), which is the most common associated anatomical factor?