Overview of Mallampati Score
Control of the airway is incredibly important in situations such as an operation or when someone needs critical medical aid. If an individual is struggling to breathe or if they’re about to be put under general anesthesia, which means they’ll be completely unconscious, it may be necessary to insert something called an endotracheal tube (ETT) or a laryngeal mask airway (LMA). These devices can help provide ventilation, meaning they can assist the person in their breathing.
If this process, which is known as intubation, isn’t carried out properly, it can lead to serious, potentially deadly, outcomes. That’s why doctors use multiple tools to evaluate patients beforehand to forecast any difficulties they might face when managing the airway.
In this piece, we’re going to look at one specific tool called the Mallampati score. It’s a quick and easy method that doctors use to inspect the arrangement of a patient’s airway. This allows them to assess if there might be any obstacles when trying to manage the patient’s airway.
Anatomy and Physiology of Mallampati Score
Your airway, the passage that air travels through from your mouth and nose to your lungs, is a vital part of how you breathe. It’s split into two main sections: the upper and lower airways. The upper airway includes parts you may be somewhat familiar with, including the nasopharynx (the area of your throat behind your nose), oropharynx (the area behind your mouth), and hypopharynx (the lower part of your throat). Meanwhile, the lower airway includes the trachea (windpipe), bronchi and bronchioles (smaller air passages in the lungs), and alveoli (tiny air sacs in the lungs where oxygen is exchanged).
The separation between these two airway sections is marked by the larynx, known to most as your voice box. It contains vital structures such as the epiglottis (a flap of tissue that prevents food and drink from entering your windpipe) and the vocal cords.
During a medical procedure called endotracheal intubation, a doctor guides a tube down your throat and into your trachea to help you breathe. If they’re using an orotracheal technique, the tube goes through your mouth and past structures in your throat such as the base of your tongue, the palatine tonsils (lymph tissues on either side of your throat), tonsillar pillars (tissue around your tonsils), and uvula (the piece of tissue that dangles at the back of your throat). If these parts are unusually large, it can make the procedure challenging.
Doctors use something called the Mallampati score to measure how big the base of your tongue is compared to the opening of your throat. This score helps them anticipate any possible difficulties with the procedure.
Why do People Need Mallampati Score
When a doctor needs to administer any form of anesthesia or carry out a process known as intubation (it involves putting a tube down a patient’s throat), they might use something called a Mallampati score. This scoring system allows them to understand and plan for any potential difficulties they might face due to the structure of the patient’s airway (the path air follows to get into and out of the lungs). It’s like having a roadmap for more safely carrying out certain medical procedures.
When a Person Should Avoid Mallampati Score
There aren’t any absolute reasons why this assessment tool can’t be used. However, its usefulness might be reduced if the patient can’t fully take part in the exam.
Who is needed to perform Mallampati Score?
This tool is beneficial for doctors and other highly trained medical professionals who frequently insert a breathing tube into patients. These experts know the proper procedures to help you breathe better if you’re having trouble doing so.
Preparing for Mallampati Score
During surgery, patients are given special medicines to help them fall asleep. These medications can affect how well the patients breathe. So once these medicines are given, the doctor performing the procedure has to help the patient breathe. They do this through a mask or by placing a device called an airway tube which provides oxygen directly to the lungs of the patient.
Although most patients can be helped to breathe easily with these methods, for about 1 to 5% of people, this can be a challenge. Sometimes medical professionals have a hard time delivering the right amount of oxygen through the mask. Other times, it can be difficult to properly place the airway tube.
Difficulties in these areas can pose significant risks to the patient. Medical reports suggest that about 67% of the complications related to airway management occur when the patient is being put to sleep for the operation. This is why doctors must try to predict which patients will have difficulty breathing, as knowing this can help them prepare better and prevent any problems.
How is Mallampati Score performed
There are a lot of different things doctors need to consider when using anesthesia. For example, they need to think about how easy it will be to put a tube down your throat to help you breathe during the procedure. To help figure this out, doctors often use a scale called the Mallampati score. This score is named after an anesthesiologist called Dr. Seshagiri Mallampati, who came up with it back in 1983.
He thought that the size of your tongue relative to the rest of your mouth might indicate how easy or difficult it would be to put the tube in. So he ran a study on 210 healthy adults to test his theory, asking each of them to sit down, open their mouth as wide as possible, and stick out their tongue. Based on what he could see inside their mouths, he split them up into three groups:
– Class I: If he could see a lot of their mouth, including the soft part at the back and the hanging thing known as the uvula, then they were put into this group.
– Class II: If he could still see the back of their mouth but not the uvula because it was being hidden by the tongue, then they were in this group.
– Class III: If he couldn’t see much at all besides just the soft part at the back of their mouth, then they were in this group.
He then found that there tended to be a connection between which group someone was in and how difficult it was to put the tube in. Just a couple years later, another group of doctors added a fourth group (Class IV) for cases where they couldn’t see anything at all. They found that if someone was in this group or in Class III, then it was usually a lot more difficult to put the tube in.
Recently, they’ve added another group (Class 0) for when you can see any part of the epiglottis, which is the flap at the base of your tongue that stops food from going into your windpipe. They found that if you can see this, then it’s usually very easy to put the tube in.
Today, your doctor will use this modified scoring system to help prepare for your procedure:
– Class 0: Any part of the epiglottis is visible
– Class I: Soft palate, uvula, and pillars are visible
– Class II: Soft palate and uvula are visible
– Class III: Only the soft palate and base of the uvula are visible
– Class IV: Only the hard palate is visible
To figure out your score, the doctor will have you sit straight up, open your mouth as wide as you can, and stick out your tongue.
What Else Should I Know About Mallampati Score?
The Mallampati scoring system, which was introduced in the 1980s, is a routine pre-surgery examination process. It helps doctors predict how challenging it will be to place a tube in a patient’s windpipe (trachea) – a process called intubation, needed to help the patient breathe during surgery. The system uses four classes (I-IV) to measure the ease of intubation, with Class III and IV traditionally indicating a potentially difficult intubation.
However, some newer studies suggest that the Mallampati scoring system may not be a very accurate standalone predictor for difficult intubations. They argue that some cases deemed ‘difficult’ by Mallampati could now be considered good based on the newer Cormack-Lehane grading system. Thus, the Mallampati score’s predictive value can be as low as 33.3% or even 22% in some situations.
Moreover, the Mallampati score does not always predict difficulties in another part of airway management – mask ventilation. This process involves providing ventilation to a patient through a facemask before intubation can be done. It is crucial in emergency situations and can sometimes be hard to perform. Again, though the Mallampati test can help, relying on it alone to predict difficulties can lead to errors.
Besides the Mallampati score, other risk factors can create difficulties during intubation and mask ventilation. These include a bulky neck, restricted neck movement, small mouth opening, limited jaw protrusion, past difficulties with intubation, older age, obesity, the presence of a beard or no teeth, being male, a history of sleep apnea, or pregnancy. Notably, a person’s Mallampati score can rise during pregnancy, likely due to fluid retention and swelling, but this doesn’t necessarily mean intubation will be more challenging.
The Mallampati score has proven useful in predicting the presence and severity of obstructive sleep apnea (a condition where the upper airway gets blocked during sleep), with increasing scores indicating higher odds of having the condition.
In conclusion, doctors use several tools and consider multiple factors, including the Mallampati scoring system when planning for intubation and ventilation during surgery. Therefore, don’t be too alarmed if a doctor examines your throat and asks you to open your mouth wide before a procedure – they’re just trying to ‘predict the unpredictable’ so they can manage your airway as safely as possible.
