Mallampati Scoring: Extend the Neck!

Extending the neck for Mallampati evaluation appears to increase specificity without reducing sensitivity for predicting difficult intubation.

The four-point modified Mallampati (MMP) score is widely used as a marker of difficult intubation. The evaluation is usually performed by having patients open their mouth and protrude their tongue with the head and neck in a neutral position. However, mouth opening has been shown to be greater when the head and neck are extended. In this study, examiners with a minimum of 1 year of airway experience performed the MMP examination on 60 adult anesthesia patients without cervical spine disease and then repeated the evaluation with the head fully extended on the cervical spine to obtain the Extended Mallampati Score (EMS).

The results of the two evaluations are presented in Table 1.

A Cormack-Lehane grade III or IV view at laryngoscopy, seen in 6…

Reviewing Author

Ron M. Walls, MD, FRCPC, FACEP, FAAEM