Clinical Definition

The Mallampati Score (or Classification) is a system used to assess the visibility of structures in the oropharynx. The patient is asked to sit upright, open their mouth as wide as possible, and stick out their tongue without phonating ("saying ahh"). The clinician then grades the view based on which structures are visible.

There are four classes:

  • Class I: Full visibility of tonsillar pillars, soft palate, and uvula.
  • Class II: Visibility of the upper part of the tonsillar pillars and uvula.
  • Class III: Soft palate and base of the uvula are visible.
  • Class IV: Only the hard palate is visible.

A higher class indicates a more crowded airway.

Etymology & History

The scoring system was proposed by Dr. Seshagiri Mallampati and colleagues in 1985 as a way to predict difficult endotracheal intubation in anesthesiology. Its application was later extended to sleep medicine as a marker for oropharyngeal crowding.

Reference Values & Interpretation

Normal Values

Class I and II are generally considered normal and are associated with a lower risk of difficult intubation and OSA.

Abnormal Values

Class III and IV are considered abnormal, indicating a restricted airway view. A high Mallampati score is an independent predictor of the presence and severity of OSA.

How It's Measured

The score is determined by a visual inspection of the patient's oropharynx. The patient sits upright, opens their mouth, and protrudes their tongue as far as possible without making a sound. The clinician observes the visibility of the soft palate, uvula, and faucial pillars.

Role in Diagnosis

A high Mallampati score (III or IV) increases the likelihood of an OSA diagnosis and can suggest the severity of the condition. It helps identify patients with oropharyngeal narrowing as a primary contributor to their sleep apnea.

Role in Treatment

The score can help guide treatment choices. Patients with a high Mallampati score may be good candidates for treatments that address the oropharynx, such as certain types of oral appliances or surgical procedures like UPPP. It also alerts anesthesiologists to take extra precautions during surgery.

Associated Conditions

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Clinical Guidelines

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Latest Research & Updates

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While a useful tool, the Mallampati score has moderate predictive value on its own. Its strength is enhanced when combined with other clinical factors like BMI and neck circumference. A modified version that includes phonation is sometimes used but is not the standard for OSA assessment.