Mallampati score

Mallampati score.

In anesthesia, the Mallampati score or Mallampati classification, named after the Indian-born American anaesthesiologist Seshagiri Mallampati, is used to predict the ease of endotracheal intubation.^[1] 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 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.^[2]

Technique

The score is assessed by asking the patient, in a sitting posture, to open his or her mouth and to protrude the tongue as much as possible.^[1] The anatomy of the oral cavity is visualized; specifically, the assessor notes whether the base of the uvula, faucial pillars (the arches in front of and behind the tonsils) and soft palate are visible. Scoring may be done with or without phonation. Depending on whether the tongue is maximally protruded and/or the patient asked to phonate, the scoring may vary.

Modified Mallampati Scoring:^[3]

Class I: Soft palate, uvula, fauces, pillars visible.
Class II: Soft palate, uvula, fauces visible.
Class III: Soft palate, base of uvula visible.
Class IV: Only hard palate visible.

Original Mallampati Scoring:^[1]

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.^[4] 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.

References

1 2 3 Mallampati, SR; Gatt, SP; Gugino, LD; Desai, SP; Waraksa, B; Freiberger, D; Liu, PL (Jul 1985). "A clinical sign to predict difficult tracheal intubation: a prospective study.". Canadian Anaesthetists' Society Journal. 32 (4): 429–34. doi:10.1007/BF03011357. PMID 4027773.
↑ Nuckton TJ, Glidden DV, Browner WS, Claman DM (Jul 1, 2006). "Physical examination: Mallampati score as an independent predictor of obstructive sleep apnea". Sleep. 29 (7): 903–8. PMID 16895257.
↑ Samsoon, GL; Young, JR (May 1987). "Difficult tracheal intubation: a retrospective study". Anaesthesia. 42 (5): 487–90. doi:10.1111/j.1365-2044.1987.tb04039.x. PMID 3592174.
↑ Lee, A; Fan, LT; Gin, T; Karmakar, MK; Ngan Kee, WD (Jun 2006). "A systematic review (meta-analysis) of the accuracy of the Mallampati tests to predict the difficult airway". Anesthesia and Analgesia. 102 (6): 1867–78. doi:10.1213/01.ane.0000217211.12232.55. PMID 16717341.

External links

Mallampati score - fpnotebook.com.
Mallampati Score

Anesthesia (outline)

Types	General Sedation Twilight anesthesia Local Topical Intercostal nerve block Neuraxial blockade Spinal Epidural Dental Inferior alveolar nerve

Techniques	Airway management Anesthesia provision in the US Arterial catheter Bronchoscopy Capnography Dogliotti's principle Drug-induced amnesia Intraoperative neurophysiological monitoring Nerve block Penthrox inhaler Tracheal intubation

Scientific Principles	Blood–gas partition coefficient Concentration effect Fink effect Minimum alveolar concentration Second gas effect

Measurements	ASA physical status classification system Baricity Bispectral index Direct Fick method Entropy monitoring Fick principle Goldman index Guedel's classification Mallampati score Neuromuscular monitoring Thyromental distance

Instruments	Anaesthetic machine Anesthesia cart Boyle's machine Gas cylinder Laryngeal mask airway Laryngeal tube Medical monitor Odom's indicator Relative analgesia machine Vaporiser Double-lumen endotracheal tube Endobronchial blocker

Complications	Emergence delirium Allergic reactions Anesthesia awareness Local anesthetic toxicity Malignant hyperthermia Perioperative mortality Postanesthetic shivering Postoperative nausea and vomiting Postoperative residual curarization

Fields of study	Cardiothoracic Geriatric Oral sedation dentistry

Professions	Anesthesiologist Anesthesiologist assistant Nurse anesthetist Operating Department Practitioners Certified Anesthesia Technician Certified Anesthesia Technologist Anaesthetic technician

History	A.C.E. mixture Helsinki Declaration for Patient Safety in Anaesthesiology History of general anesthesia History of neuraxial anesthesia History of tracheal intubation

Organizations	American Association of Nurse Anesthetists American Society of Anesthesia Technologists & Technicians American Society of Anesthesiologists Anaesthesia Trauma and Critical Care Association of Anaesthetists of Great Britain and Ireland Association of Veterinary Anaesthetists Australian and New Zealand College of Anaesthetists Australian Society of Anaesthetists International Anesthesia Research Society

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Mallampati score

Technique

Clinical significance

See also

References

External links