Modified Mallampati Classification
Predicts difficult laryngoscopy and intubation based on oropharyngeal visualisation. Class III/IV indicates potentially difficult airway. Assess with mouth fully open, tongue not protruded, no phonation.
Score interpretation
Mallampati Class I: Full oropharyngeal view. Easy airway anticipated.
→ Routine anaesthetic management. Standard direct laryngoscopy anticipated to be straightforward. Cormack-Lehane Grade 1 expected.
Mallampati Class II: Good oropharyngeal view. Intubation generally straightforward.
→ Standard direct laryngoscopy. Anticipate Cormack-Lehane Grade 1–2. Routine backup plan. BURP manoeuvre if needed.
Mallampati Class III: Limited view. Potentially difficult laryngoscopy (Cormack-Lehane Grade 3).
→ Prepare difficult airway trolley. First-line: video laryngoscopy. Have second skilled anaesthetist available. Consider awake fibreoptic intubation if multiple difficult airway predictors present (BMI >35, limited neck extension, short thyromental distance).
Mallampati Class IV: Very poor view. High probability of difficult or failed intubation.
→ Difficult airway management plan mandatory. Video laryngoscopy as first-line technique. Strongly consider awake fibreoptic intubation before induction. Have surgical airway plan (cricothyroidotomy kit). Do NOT proceed without expert airway anaesthetist. Inform team of CICO (cannot intubate, cannot oxygenate) risk.
Interpretation bands for the Mallampati. Apply clinical judgement and local guidance.
References
- Mallampati SR et al. A clinical sign to predict difficult tracheal intubation. Can Anaesth Soc J. 1985.
- Samsoon GL, Young JR. Difficult tracheal intubation: a retrospective study. Anaesthesia. 1987.
Related
Curated clinical cross-links plus same-class fallbacks.
- Ketamine (Anaesthesia/Sedation) · Dissociative Anaesthetic (NMDA Receptor Antagonist)
- Morphine (IV/IM — Anaesthesia/ICU) · Strong Opioid Analgesic
- Suxamethonium (Anaesthesia/RSI) · Depolarising Neuromuscular Blocking Agent
- Rocuronium (Anaesthesia/RSI) · Non-Depolarising Neuromuscular Blocking Agent
- Fentanyl (IV — Anaesthesia/ICU) · Opioid Analgesic (Short-Acting)
- Lidocaine (IV — Anaesthesia/ICU) · Local Anaesthetic / Antiarrhythmic (Class Ib)
- Difficult Airway Algorithm (DAS) · DAS 2015; Royal College of Anaesthetists
- Major Haemorrhage Protocol · NICE NG24; UK MHP guidelines
- New-Onset Atrial Fibrillation · ESC 2020 AF Guidelines; NICE NG196
- Hypertensive Emergency · ESC/ESH 2018 Hypertension Guidelines; NICE NG136
- Bradycardia Management · Resuscitation Council UK ABCDE; ESC 2021 Pacing Guidelines
- Ventricular Tachycardia / Fibrillation · Resuscitation Council UK ACLS; ESC 2022 Ventricular Arrhythmia Guidelines
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.