The Mallampati score is a classification system used to predict the ease of endotracheal intubation based upon the anatomical structures visible during examination. A Mallampati score of 3 or 4 is associated with increased risk for difficult intubation.
The Mallampati score is assessed while the patient is sitting in an upright position with an open mouth and attempting to protrude the tongue as much as possible without phonation. The score may vary considerably if the patient is not attempting maximal tongue extrusion or is phonating.
|I (1)||Soft palate, entire uvula, fauces, pillars|
|II (2)||Soft palate, majority of uvula, fauces|
|III (3)||Soft palate, base of uvula|
|IV (4)||Only hard palate|
|1||Soft palate, entire uvula, facues, pillars|
|2||Soft palate, part of uvula, fauces, pillars|
|3||Only soft palate|
|Outcome||Summary sensitivity (95% CI)||Summary specificity|
|Difficult direct laryngoscopy||0.53 (0.47 to 0.59)||0.80 (0.74 to 0.85)|
|Difficult intubation||0.51 (0.40 to 0.61)||0.87 (0.82 to 0.91)|
|Difficult mask ventilation||0.17 (0.06 to 0.39)||0.90 (0.81 to 0.95)|
A meta-analysis of 133 studies with 844,206 participants suggested that the modified Mallampati score is a good predictor of difficult direct laryngoscopy and difficult intubation, but a poor predictor of difficult ventilation. The same analysis also suggested that the modified Mallampati score was the best predictor of difficult intubation of the predictive metrics studied.
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