Mallampati Test as a Predictor of Laryngoscopic View

Abstract

Aim.To determine the accuracy of the modified Mallampati test for predicting difficult tracheal intubation. Design. A cross-sectional, clinical, observational, non-blinded study. A quality analysis of anesthetic care. Setting. Operating theatres and department of anesthesiology in a university hospital. Material and methods. Following the local ethics committee approval and patients' informed consent to anesthesia, all adult patients (> 18 yrs) presenting for any type of non-emergency surgical procedures under general anesthesia requiring endotracheal intubation were enrolled. Prior to anesthesia, Samsoon and Young's modification of the Mallampati test (modified Mallampati test) was performed. Following induction, the anesthesiologist described the laryngoscopic view using the Cormack-Lehane scale. Classes 3 or 4 of the modified Mallampati test were considered a predictor of difficult intubation. Grades 3 or 4 of the Cormack-Lehane classification of the laryngoscopic view were defined as impaired glottic exposure. The sensitivity, specificity, positive and negative predictive value, relative risk, likelihood ratio and accuracy of the modified Mallampati test were calculated on 2x2 contingency tables.Results. Of the total 1,518 patients enrolled, 48 had difficult intubation (3.2%). We failed to detect as many as 35.4% patients in whom glottis exposure during direct laryngoscopy was inadequate (sensitivity 0.646). Conclusion. When used as a single examination, the modified Mallampati test is of limited value in predicting difficult intubation.

Can Difficult Intubation Be Easily and Rapidly Predicted?

“…In the literature, class 3 means up to 7.5-8 times higher risk for difficult intubation. But a 1992 German study showed that only 6.4% of class 4 patients were difficult to intubate 3,5 . Although ULBT is a statistically significant test, in some cases such as elderly patients with artificial dentition, it may be more difficult to understand and perform.…”

“…The actual predictive value is approximately 50% (ref. 3,5 ). In the literature, class 3 means up to 7.5-8 times higher risk for difficult intubation.…”

“…4 ), pathologies associated with difficult intubation 4 , clinical symptoms of airway pathology 4 , the Mallampati score 3,5 , upper lip bite test (ULBT) (ref.…”

Does Surgical Release of Neck Burn Contracture Result in Airway Improvement?

“…The most notable and frequently used clinical signs are the extent of neck mobility, the Mallampati score, the McCormack and Lehane score, and the thyromental distance. The Mallampati score is a numerical score ranging from 1 to 4 given to a patient based on visualization of intraoral anatomical landmarks when a patient opens his/her mouth; with a score of 1 signifying visualization of fauces, pillars, soft palate, and uvula; score of 2 given upon visualization of fauces, soft palate, and uvula; score of 3 given upon visualization of soft palate and base of uvula; and a score of 4 signifying visualization of only the hard palate [4,5].…”

“…The Cormack and Lehane Classification system grades visualization of an airway during direct laryngoscopy into 4 grades, with grade 1 providing a full view of the glottis including the airway, grade 2 giving a patial glottis view, grade 3 affording a view only of the epiglottis, and grade 4 furnishing only a view of the soft palate without epiglottis visualization [4,5].…”