[The Mallampati Score. Prediction of difficult intubation in otolaryngologic laser surgery by Mallampati Score]

Abstract

The Mallampati score (MS), later modified by Samsoon and Young, is a common method used to predict difficult intubation. We tested its predictive value in otolaryngologic (ENT) laser surgery.

Methods: Ninety-one patients scheduled for elective ENT laser surgery had the modified MS noted prior to induction in the supine position, with the tongue fully protruded and phonating "ah"; 22 patients were female, 69 male. The mean age was 54 +/- 15 (6-84) years, height 171 +/- 9 (130-190) cm, and weight 72 +/- 21 (20-99) kg. After a standard induction, the laryngoscopic view was graded according to Cormack and Lehane (C&L). An intubation was considered difficult if the C&L score was > or = 3, i.e., no part of the glottis seen during laryngoscopy. The hypothesis tested was that a MS > or = 3 (i.e., only the base of the uvula or nine of the uvula was seen) is predictive of difficult intubation in this group of patients. This chi-square test was used for calculation of significance.

Results: All intubations were performed in less than three attempts, and no C&L score of 4 (i.e., not even the epiglottis seen during laryngoscopy) was observed; 10 patients had a C&L score > or = 3, i.e., a difficult intubation according to our definition. Sixty-two patients had a MS < or = 2; of these, 4 (= 6%) were difficult to intubate. Twenty-nine patients had MS > or = 3; of these, 6 (= 21%) were difficult to intubate. This difference was significant (chi-square = 4.1, P < 0.05).

Conclusion: Difficult intubation was significantly more common in patients with MS > or = 3. Low sensitivity (60%) and specificity (72%) limit the clinical value of this test, however.