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.[1]


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.[1] The score may vary considerably if the patient is not attempting maximal tongue extrusion or is phonating.


This image shows examples of the 4 classifications of the modified Mallampati score
Modified Mallampati score
Modified Mallampati score[2]
Class Visible structures
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
Original Mallampati score[1]
Class Visible structures
1 Soft palate, entire uvula, facues, pillars
2 Soft palate, part of uvula, fauces, pillars
3 Only soft palate


Results of a meta-analysis evaluation of the Modified Mallampati score[3]
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.[3] The same analysis also suggested that the modified Mallampati score was the best predictor of difficult intubation of the predictive metrics studied.


  1. 1.0 1.1 1.2 Mallampati, S. R.; Gatt, S. P.; Gugino, L. D.; Desai, S. P.; Waraksa, B.; Freiberger, D.; Liu, P. L. (1985). "A clinical sign to predict difficult tracheal intubation: a prospective study". Canadian Anaesthetists' Society Journal. 32 (4): 429–434. doi:10.1007/BF03011357. ISSN 0008-2856. PMID 4027773.
  2. Samsoon, G. L.; Young, J. R. (1987). "Difficult tracheal intubation: a retrospective study". Anaesthesia. 42 (5): 487–490. doi:10.1111/j.1365-2044.1987.tb04039.x. ISSN 0003-2409. PMID 3592174.
  3. 3.0 3.1 Roth, Dominik; Pace, Nathan L.; Lee, Anna; Hovhannisyan, Karen; Warenits, Alexandra-Maria; Arrich, Jasmin; Herkner, Harald (2018-05-15). "Airway physical examination tests for detection of difficult airway management in apparently normal adult patients". The Cochrane Database of Systematic Reviews. 5: CD008874. doi:10.1002/14651858.CD008874.pub2. ISSN 1469-493X. PMC 6404686. PMID 29761867.