Modified Mallampati Score

Mallampati SR, Gatt SP, Gugino LD, et al. A clinical sign to predict difficult tracheal intubation: a prospective study. Related the visibility of oropharyngeal structures to the laryngoscopic view; a higher class predicted a worse view.

Samsoon GLT, Young JRB. Difficult tracheal intubation: a retrospective study. Added class IV (only hard palate visible), producing the four-grade modified Mallampati score in current use.

The modified Mallampati score is one component of airway assessment. Used alone its sensitivity for difficult intubation is limited (~50%); combine it with thyromental distance, mouth opening, neck mobility, jaw protrusion and history, and have a difficult-airway plan ready when several predictors are abnormal.