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Modified Mallampati Classification

Calculators  Respiratory
Modified Mallampati Classification measures the difficulty of performing endotracheal intubation by anotmic features
Visualization
Faucial pillars, soft palate, and uvula visualized 1
Faucial pillars and soft palate visualized, but uvula masked by tongue base 2
Only soft palate visualized 3
Soft palate not visualized 4
Result:

Background

Measured Factor
Anotmical features
Measured Factor Disease
  • Difficulty in performing endotracheal intubation
Measured Factor Detail
Modified mallampati classification appears to be clincally effective predictor to classify the candidates of endotracheal intubation based on anotmical features. There are four classes and higher class indicates more difficulty in performing anesthetic endotracheal intubation.
Speciality
Multi-Speciality
Body System
Respiratory
Measured Factor Low Impact
  • Class 1 indicates ease of performing endotracheal intubation
Measured Factor High Impact
  • Class IV is indicator of difficulty in performing endotracheal intubation as the view is blocked completly.

Result Interpretation

Ranges Ranges
  • Critical High: Class IV
  • Normal: Class 1
  • Normal Adult Male: Class 1
  • Normal Adult Female: Class 1
  • Normal Pediatric: Class 1
  • Normal Neonate Female: Class 1
  • Normal Geriatric Male: Class 1
  • Normal Geriatric Female: Class 1
Result High Conditions
  • Gag reflex
  • hypertension
  • tachycardia
Test Limitations
The modified Mallampati score showed worse results as compared to the previous meta-analysis for tracheal intubation.
References: 2

Studies

Study Validation 1
A meta-analysis was conducted to identify the validity of the modified Mallampati test for difficult airway. 34,513 patients were included in 42 studies having airway difficulty with difficult intubation, difficult laryngoscopy, or difficult ventilation. Modified Mallampati test and The original Mallampati test both had 0.78 ± 0.05 and 0.89 ± 0.05 respectively area under the summary receiver operating characteristic (sROC) curve with good accuracy for predicting laryngoscopy difficulty. Modified Mallampati test had good accuracy as compared to The original Mallampati test with 0.83 ± 0.03 and 0.58 ± 0.12 respectively for intubation difficulty. In conclusion, the modified Mallampati test is more accurate than The original Mallampati test for difficult airway.
References: 3
Study Validation 2
A study was conducted to validate the modified Mallampati test (MMT) to predict difficult intubation with sternomental distance (SMD) and thyromental distance (TMD). 135 adult patients were enrolled in assessed oropharynx by the anaesthesiologist. MMT had 28.6% sensitivity and 93% specificity, TMD had 100% sensitivity and 75.8% specificity, and SMD had 91% sensitivity and 92.7% specificity. Combination of MMT with TMD and SMD had more sensitivity (100%) and specificity (92.7%). In conclusion, the combination of MMT with SMD and TMD had high validity than MMT alone to predict difficult intubation.
References: 4
Study Validation 3
A prospective distribution study was conducted to evaluate sensitivity of modified Mallampati test (MMT), 3-3-2 rule and Palm print to predict difficult intubation. 500 patients were enrolled in assessed airway by the anaesthesiologist. 8.9% of patients were reported with difficult intubation. MMT had the highest specificity (98.40%) and palm print had the highest specificity (96.46%) as compared to these three tests. In combination, these had more sensitivity and specificity than alone. In conclusion, combination of MMT with the 3-3-2 rule and palm print had high validity than MMT alone to predict difficult intubation.
References: 5
Study Additional 1
A study was conducted to evaluate modified Mallampati test (MMT) in supine position to predict difficult intubation. 123 patients (aged: 18-60 years) were enrolled in assessed airway intubation with MMT in supine or sitting position. The original Mallampati test and modified Mallampati test by Samsoon and Young both were evaluated in sitting posiong with Cormack-Lehane grade. This study was performed to evaluate MMT with the supine position. Study concluded that the MMT had high positive predictive value in supine position than sitting position.
References: 6
Study Additional 2
A study was conducted to evaluate modified Mallampati test (MMT) with the effect of posture to predict difficult intubation. 80 adult patients (aged: 18-65 years) were enrolled to assessed airway intubation with MMT in supine or sitting position. The original Mallampati test and modified Mallampati test by Samsoon and Young both were evaluated in sitting posiong with Cormack-Lehane grade. This study was performed to evaluate MMT with the supine position. Study concluded that the MMT had high positive predictive value with the change of posture in mouth openings than sitting position.
References: 7
Study Additional 3
A study was conducted to compare modified Mallampati test (MMT) with upper lip bite test (ULBT) to predict difficult intubation. 50 patients were enrolled to assessed airway intubation with MMT and ULBT. MMT and ULBT both were evaluated with Cormack-Lehane grade. The Cormack-Lehane grade and the MMT and ULBT test had no relationship, but Cormack-Lehane grade and ULBT had significant relationship with r = 0.512 and p < 0.001. The ULBT had high sensitivity, specificity, positive predictive value, and accuracy (55%, 97%, 83%, and 90% respectively) as compared to MMT with (11%, 75%, 9%, and 64% respectively). In conclusion, the ULBT has better results than the MMT for difficult intubation prediction.
References: 8

References

  1. Mallampati SR, Gatt SP, Gugino LD, et al. A clinical sign to predict difficult tracheal intubation: a prospective study. Can Anaesth Soc J. 1985;32(4):429-34.
  2. Lundstrøm LH, Vester-andersen M, Møller AM, Charuluxananan S, L'hermite J, Wetterslev J, et al. Poor prognostic value of the modified Mallampati score: a meta-analysis involving 177 088 patients. Br J Anaesth. 2011;107(5):659-67.
  3. Lee A, Fan LT, Gin T, Karmakar MK, Ngan kee WD. A systematic review (meta-analysis) of the accuracy of the Mallampati tests to predict the difficult airway. Anesth Analg. 2006;102(6):1867-78.
  4. Patel B, Khandekar R, Diwan R, Shah A. Validation of modified Mallampati test with addition of thyromental distance and sternomental distance to predict difficult endotracheal intubation in adults. Indian J Anaesth. 2014;58(2):171-5.
  5. Mahmoodpoor A, Soleimanpour H, Nia KS, Panahi JR, Afhami M, Golzari SEJ, et al. Sensitivity of palm print, modified mallampati score and 3-3-2 rule in prediction of difficult intubation. Int J Prev Med. 2013;4(9):1063-9.
  6. Bindra A, Prabhakar H, Singh GP, Ali Z, Singhal V. Is the modified Mallampati test performed in supine position a reliable predictor of difficult tracheal intubation?. J Anesth. 2010;24(3):482-5.
  7. Singhal V, Sharma M, Prabhakar H, Ali Z, Singh GP. Effect of posture on mouth opening and modified Mallampati classification for airway assessment. J Anesth. 2009;23(3):463-5.
  8. Hester CE, Dietrich SA, White SW, Secrest JA, Lindgren KR, Smith T. A comparison of preoperative airway assessment techniques: the modified Mallampati and the upper lip bite test. AANA J. 2007;75(3):177-82.