Airway Assessment

TONGUE ABNORMALITIES
Direct laryngoscopy requires the tongue to be mobile and retracted from the line of vision.
Problems arise when the tongue is abnormally large or poorly compliant. Rosenstock and
Kristensen suggest that tongue mobility may be a sensitive indicator of difficult laryngoscopy 45 .
MALLAMPATI
Three classes were initially described by Mallampati with Samsoon and Young 46 adding a
fourth later 47,48 . The use of the latter four-class classification is often referred to as a modified
Mallampati score (Table 16). The score is based on the visibility of pharyngeal structures with
the patient sitting directly opposite the examiner, mouth open as widely as possible and the
tongue maximally extruded and no vocalisation (Figure 2). The test serves to estimate the
relative size of the tongue to the oral cavity and likely ease or difficulty in displacing the tongue
with a standard laryngoscope in order to view the glottis 26,49,50 .
Figure 2. Modified Mallampati scoring system.
Table 16. Modified Mallampati scoring system.
Class Pharyngeal structures visible
1 Faucial pillars, soft palate and uvula visible
2 Faucial pillars and soft palate visible. Uvula obscured by tongue
3 Only the soft palate is visible
4 Soft palate not visible
21 Airway Assessment