What is the Mallampati classification?

A bedside grading of the oropharyngeal view with the mouth open and tongue protruded. In the modified (Samsoon-Young) scale, Class I shows the soft palate, fauces, uvula and pillars; Class II the soft palate, fauces and uvula; Class III the soft palate and base of the uvula; Class IV only the hard palate.

What is a normal Mallampati score?

Classes I and II are usually regarded as reassuring, and Classes III and IV as predictors of a difficult laryngoscopy or intubation. A low class does not rule out a difficult airway: in the Cochrane review the modified test missed about half of difficult laryngoscopies.

What is the difference between the original and modified Mallampati scores?

Mallampati (1985) used three classes: 1, faucial pillars, soft palate and uvula visible; 2, pillars and soft palate visible with the uvula masked by the tongue; 3, only the soft palate visible. Samsoon and Young (1987) split the worst view into Class III (soft palate and base of uvula) and Class IV (soft palate not visible).

What is Mallampati Class 0?

A later proposed class for the uncommon finding that the tip of the epiglottis is visible when the tongue is protruded. It has been associated with easy laryngoscopy (Ezri et al., 2001) but is not part of the standard four-class scale.

Should the patient say "ahh" during the exam?

No. The standard technique is without phonation, because saying "ahh" lifts the soft palate and can improve the class by one grade. If phonation is used, record it, and use the same technique at each assessment.

How does Mallampati relate to Cormack-Lehane?

Mallampati grades the view of the mouth before induction; Cormack-Lehane grades the view of the larynx during laryngoscopy (1 = most of the glottis, 2 = posterior glottis only, 3 = epiglottis only, 4 = no glottis or epiglottis). Higher Mallampati classes make Cormack-Lehane 3–4 more likely, but the correlation is moderate.

Can the Mallampati class change?

Yes. It can worsen with weight gain, pregnancy and during labour (Kodali et al., 2008, found the class rose in a substantial share of women during labour), with airway oedema, and with head or neck position. Reassess close to the time of anaesthesia.

Mallampati Score Airway Assessment

Pick a Mallampati class (I–IV) to see which pharyngeal structures are visible and what it implies, compare the original and modified scales, check how accurate the test is, and tally a LEMON airway checklist. Educational reference, not medical advice.

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.

Relative Difficulty (qualitative)

An ordinal illustration of the class, not a probability of failed intubation.

Easy Difficult

—

Clinical Guidance

Select a class to see guidance.

Quick Reference — All Classes

Class	Visible structures (modified, Samsoon-Young 1987)	Usual reading
0	Tip of the epiglottis visible (proposed later; not part of the standard scale)	Easy laryngoscopy reported
I	Soft palate, fauces, uvula, faucial pillars	Reassuring
II	Soft palate, fauces, uvula (pillars hidden)	Reassuring
III	Soft palate and base of uvula	Predicts difficulty
IV	Soft palate not visible; hard palate only	Predicts difficulty

How accurate is the Mallampati test?

Pooled diagnostic accuracy in apparently normal adults, Cochrane review (Roth et al., 2018). Studies (participants) in brackets.

Outcome	Test	Sensitivity (95% CI)	Specificity (95% CI)
Difficult laryngoscopy	Modified Mallampati (80; 232,939)	0.53 (0.47–0.59)	0.80 (0.74–0.85)
Difficult laryngoscopy	Original Mallampati (6; 2,165)	0.40 (0.16–0.71)	0.89 (0.75–0.96)
Difficult laryngoscopy	Upper lip bite test (27; 19,609)	0.67 (0.45–0.83)	0.92 (0.86–0.95)
Difficult laryngoscopy	Thyromental distance (42; 33,189)	0.37 (0.28–0.47)	0.89 (0.84–0.93)
Difficult laryngoscopy	Sternomental distance (16; 12,211)	0.33 (0.16–0.56)	0.92 (0.86–0.96)
Difficult laryngoscopy	Mouth opening (24; 22,179)	0.22 (0.13–0.33)	0.94 (0.90–0.97)
Difficult laryngoscopy	Wilson risk score (5; 5,862)	0.51 (0.40–0.61)	0.95 (0.88–0.98)
Difficult tracheal intubation	Modified Mallampati (24; 191,849)	0.51 (0.40–0.61)	0.87 (0.82–0.91)
Difficult face-mask ventilation	Modified Mallampati (6; 56,323)	0.17 (0.06–0.39)	0.90 (0.81–0.95)

High specificity with low sensitivity means a Class III–IV finding is a useful warning, but a Class I–II finding misses many difficult airways.

Original Mallampati scale (1985)

Class	Visible structures
1	Faucial pillars, soft palate and uvula
2	Faucial pillars and soft palate; uvula masked by the base of the tongue
3	Soft palate only

Samsoon and Young (1987) added a fourth class for a view of the hard palate only. Most pooled studies use the modified four-class scale.

Cormack-Lehane laryngoscopy grades

Grade	View at direct laryngoscopy
1	Most of the glottis visible
2	Only the posterior glottis or arytenoids visible
3	Only the epiglottis visible
4	Neither glottis nor epiglottis visible

Grades 3–4 define difficult laryngoscopy in most accuracy studies. Mallampati is assessed before induction; Cormack-Lehane during laryngoscopy.

Limitations and sources

Inter-observer agreement is only moderate; phonation, head extension and incomplete tongue protrusion change the class.
The class can worsen with pregnancy and labour, weight gain and airway oedema, so reassess close to anaesthesia.
The Friedman tongue position used in sleep medicine is a different exam (tongue kept inside the mouth) and is not interchangeable with Mallampati.

Not medical advice. Educational reference only. Airway assessment and management decisions must be made by a qualified healthcare professional who has examined the patient, following local guidelines.

Summary

The Mallampati classification is a bedside test that grades how much of the oropharynx is visible when a seated patient opens the mouth fully and protrudes the tongue without speaking. Mallampati described three classes in 1985; Samsoon and Young added a fourth in 1987, and this modified Class I–IV scale is the one used today (a Class 0, with the epiglottis visible, was proposed later). Higher classes are associated with a poorer laryngoscopic view, but the 2018 Cochrane review found a pooled sensitivity of only 0.53 and specificity of 0.80 for difficult laryngoscopy, so the score should be combined with other predictors such as the upper lip bite test, thyromental distance, mouth opening and neck mobility. This page shows each class with its anatomy, compares the original and modified scales, lists the accuracy data and related grading systems, and includes a LEMON checklist. It is an educational reference and not medical advice.

How it works

Seat the patient upright with the head in a neutral position, at the examiner's eye level.
Ask the patient to open the mouth as wide as possible and protrude the tongue as far as possible, without phonating (no "ahh").
Note the structures visible: soft palate, fauces, uvula and faucial (tonsillar) pillars. Repeat once to confirm the view.
Assign the modified class: I = all four visible; II = soft palate, fauces and uvula; III = soft palate and base of uvula; IV = soft palate not visible (hard palate only).
Record the class with other predictors (mouth opening, thyromental distance, upper lip bite test, neck movement) and use the LEMON checklist below for a structured summary.

Use cases

Learning or teaching the Mallampati exam technique and the four modified classes.
Checking the difference between the original 1985 three-class scale and the Samsoon-Young four-class scale.
Looking up the published sensitivity and specificity of Mallampati and other bedside airway tests.
Relating Mallampati classes to Cormack-Lehane laryngoscopy grades.
Structuring a pre-anesthetic airway note with the LEMON mnemonic.

Frequently Asked Questions

Last updated: 2026-10-09 · Reviewed by Nham Vu