Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Mar;58(2):171-5.
doi: 10.4103/0019-5049.130821.

Validation of modified Mallampati test with addition of thyromental distance and sternomental distance to predict difficult endotracheal intubation in adults

Bhavdip Patel  1 , Rajiv Khandekar  1 , Rashesh Diwan  2 , Ashok Shah  2
Affiliations

Validation of modified Mallampati test with addition of thyromental distance and sternomental distance to predict difficult endotracheal intubation in adults

Bhavdip Patel et al. Indian J Anaesth. 2014 Mar.

Abstract

Background and aims: Intubation is often a challenge for anaesthesiologists. Many parameters assist to predict difficult intubation. The present study was undertaken to assess the validity of different parameters in predicting difficult intubation for general anaesthesia (GA) in adults and effect of combining the parameters on the validity.

Methods: The anaesthesiologist assessed oropharynx of 135 adult patients. Modified Mallampati test (MMT) was used and the thyromental distance (TMD) and sternomental distances (SMD) for each of the patients were also measured. The Cormack and Lehane laryngoscopic grading was assessed following laryngoscopy. The validity parameters such as sensitivity, specificity, false positive and negatives values, positive and negative predictive values were calculated. The effect of combining different measurements on the validity was also studied. Univariate analysis was performed using the parametric method.

Results: The study group comprised of 135 patients. The sensitivity and specificity of MMT were 28.6% and 93%, respectively. The TMD (<6.5 CM) had sensitivity and specificity of 100% and 75.8%, respectively. The SMD (<12.5 CM) had sensitivity and specificity of 91% and 92.7%, respectively. Combination of MMT grading and TMD and SMD measurements increased the validity (sensitivity of 100% and specificity of 92.7%).

Conclusion: MMT had high specificity. The validity of combination of MMT, SMD and TMD as compared to MMT alone was very high in predicting difficult intubation in adult patients. All parameters should be used in assessing an adult patient for surgery under GA.

Keywords: Anaesthesia; endotracheal intubation; modified Mallampatti test; validity.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Validity of ‘Thyro-Mental Distance’in predicting difficulty in endotracheal intubation. Sensitivity= 90% and specificity= 90%
Figure 2
Figure 2
Validity of ‘Sterno Mental Distance’in predicting difficulty in endotracheal intubation. Sensitivity= 80% and specificity= 90%
See this image and copyright information in PMC

References

    1. Ali MA, Qamar-ul-Hoda M, Samad K. Comparison of upper lip bite test with Mallampati test in the prediction of difficult intubation at a tertiary care hospital of Pakistan. J Pak Med Assoc. 2012;62:1012–5. - PubMed
    1. Gupta S, Pareek S, Dulara SC. Comparison of two methods for predicting difficult intubation in obstetric patients. Middle East J Anesthesiol. 2003;17:275–85. - PubMed
    1. Moon HY, Baek CW, Kim JS, Koo GH, Kim JY, Woo YC, et al. The causes of difficult tracheal intubation and preoperative assessments in different age groups. Korean J Anesthesiol. 2013;64:308–14. - PMC - PubMed
    1. Langeron O, Cuvillon P, Ibanez-Esteve C, Lenfant F, Riou B, Le Manach Y. Prediction of difficult tracheal intubation: Time for a paradigm change. Anesthesiology. 2012;117:1223–33. - PubMed
    1. Ittichaikulthol W, Chanpradub S, Amnoundetchakorn S, Arayajarernwong N, Wongkum W. Modified Mallampati test and thyromental distance as a predictor of difficult laryngoscopy in Thai patients. J Med Assoc Thai. 2010;93:84–9. - PubMed