What is the Mallampati classification?

It is a four-class system (I-IV) used to estimate ease of endotracheal intubation based on how much of the oropharynx is visible when a seated patient opens the mouth and protrudes the tongue. Class I is unrestricted; Class IV shows only the hard palate.

Which Mallampati class predicts difficult intubation?

Class III and Class IV are associated with a significantly higher probability of difficult or failed direct laryngoscopy. These classes warrant additional airway equipment, backup plans, and experienced personnel.

Should the patient phonate during the exam?

The original Mallampati protocol is performed without phonation to standardize the view. Allowing phonation can artificially elevate the soft palate and improve the apparent class — use consistent technique within your institution.

Is Mallampati alone sufficient to predict a difficult airway?

No. Mallampati has moderate sensitivity and specificity in isolation. It should be used alongside the LEMON framework (Look, Evaluate 3-3-2, Mallampati, Obstruction, Neck mobility) and other predictors for a complete assessment.

How does obesity affect the score?

Obesity increases soft-tissue bulk in the oropharynx and pharynx, often worsening the Mallampati class. Obese patients with Class III-IV carry materially elevated intubation risk and should be assessed in the ramped position.

Does this tool replace a clinical examination?

No. This is an educational reference only. Clinical airway assessment must be performed by a qualified healthcare professional in the context of the individual patient.

Mallampati Score Airway Assessment

Name: Mallampati Score Airway Assessment
Availability: InStock
Author: Nham Vu

Click any Mallampati class (I-IV) to see the oropharyngeal view criteria, intubation risk level, and recommended clinical actions.

Select a class to view its criteria and clinical guidance:

Oropharyngeal View

Soft palate

Fauces

Uvula

Pillars

Structures Visible on Exam

Select a class above.

Class —

Select a class to begin

Click one of the four class buttons above.

Intubation Difficulty Estimate

Easy Difficult

—

Clinical Guidance

Select a class to see guidance.

Quick Reference — All Classes

Class	Visible Structures	Risk
I	Soft palate, fauces, uvula, tonsillar pillars	Low
II	Soft palate, fauces, uvula (pillars obscured)	Mildly elevated
III	Soft palate and base of uvula only	Elevated
IV	Hard palate only (no soft tissue)	High

For educational and reference use only. All clinical airway assessments and management decisions must be made by a qualified healthcare professional based on the full clinical context of the individual patient.

Summary

Click any Mallampati class (I-IV) to see the oropharyngeal view criteria, intubation risk level, and recommended clinical actions.

How it works

Ask the patient to sit upright, open the mouth fully, and protrude the tongue without making any sound.
Look into the oropharynx under good lighting and note which structures are visible: soft palate, fauces, uvula, and tonsillar pillars.
Select the class on this page that matches the visible anatomy — or browse all four classes to compare.
Review the risk level and clinical guidance displayed for the selected class.
Combine the Mallampati result with other predictors (thyromental distance, mouth opening, neck mobility) for a complete pre-anesthetic airway assessment.

Use cases

Quick bedside airway classification before elective or emergency intubation.
Teaching medical students and residents the Mallampati exam technique.
Pre-operative documentation of airway class by anesthesiologists and CRNAs.
ICU admission airway risk stratification to guide intubation planning.
Obstetric and labor-ward airway assessment prior to regional or general anesthesia.

Frequently Asked Questions

Last updated: 2026-07-23 · Reviewed by Nham Vu