What is the Mallampati test?

It is a physical examination maneuver in which a seated patient opens their mouth and protrudes their tongue. The clinician assigns a class (I-IV) based on which oropharyngeal structures remain visible, predicting ease of direct laryngoscopy.

Which class indicates a difficult airway?

Class III and IV are associated with a higher probability of difficult intubation. Class III shows only the soft palate and base of uvula; Class IV shows only the hard palate. Both warrant additional airway equipment and personnel at hand.

Is Mallampati score alone sufficient to predict difficult intubation?

No. Mallampati has moderate sensitivity and specificity when used in isolation. It should be combined with other predictors such as thyromental distance, mouth opening, neck mobility, and the LEMON law for a more complete assessment.

How does obesity affect the Mallampati score?

Obesity often worsens the Mallampati class due to increased soft tissue in the oropharynx. Obese patients with Class III-IV scores carry significantly elevated difficult-airway risk and should be assessed in the ramped (sniffing) position.

Should the patient phonate during the exam?

The original Mallampati protocol is performed without phonation to standardize the view. Some modifications allow phonation, which can elevate the soft palate and artificially improve the class — be consistent with your institutional protocol.

Mallampati Score Helper

Name: Mallampati Score Helper
Availability: InStock
Author: Nham Vu

Select visible oropharyngeal structures to determine Mallampati Class (I-IV) and assess difficult intubation risk.

Visible Structures

Check every structure you can see when the patient opens their mouth and protrudes their tongue (no phonation).

Class —

Select structures to begin

Check one or more structures on the left to see the corresponding Mallampati class.

Intubation Difficulty Estimate

Easy Difficult

—

Clinical Guidance

Select structures above to see guidance.

Anatomy Reference

Soft palate

Uvula / fauces

Tonsillar pillars

Tongue

Summary

Select visible oropharyngeal structures to determine Mallampati Class (I-IV) and assess difficult intubation risk.

How it works

Have the patient sit upright, open their mouth as wide as possible, and maximally protrude their tongue without phonating.
Inspect the oropharynx and note which structures are visible: soft palate, fauces (isthmus), uvula, and tonsillar pillars.
Select the observed structures in the tool — it maps your findings to the corresponding Mallampati class.
Review the class description, intubation difficulty estimate, and recommended clinical actions.
Document the result in the pre-anesthetic record and plan airway management accordingly.

Use cases

Pre-operative airway assessment by anesthesiologists and CRNAs.
Emergency department rapid intubation planning.
Teaching medical students and residents airway evaluation technique.
Quick bedside reference for resident physicians and nurses.
Documenting airway class for obstetric epidural and intubation planning.
ICU admission airway risk stratification.

Frequently Asked Questions

Last updated: 2026-06-09 · Reviewed by Nham Vu