Mallampati 'Zero' Airway: Extremely Easy or Not?

Abstract

To the Editor, An epiglottis that is seen during laryngoscopy is a relief for the anesthetist, but what should one feel if the epiglottis is seen by mouth opening, during Mallampati class examination? Since Ezri suggested to add a new class, ‘class zero airway,’ to the Mallampati classification (1), there has been a debate whether the epiglottis seen by mouth opening is a sign of ‘extremely’ easy intubation or not. There are no randomized, controlled studies assessing the ease of intubation of this class; so, prevalence studies and case reports become more important. Nevertheless, the results of them are varied and limited. We want to present a (another) case of easy intubation with class zero airway and want to emphasize the importance of weight in the prediction of ease of intubation. A 27-year-old female, 47 kg and 163 cm, was admitted for rhinoplasty. Her epiglottis was seen during Mallampati examination (Figure 1), and her Cormack Lehane laryngoscopy grade was I. She was easily intubated in the first attempt. Figure 1 View of Epiglottis in Mallampati Class Zero Airway Tobolt in 1869 was the first to describe that the epiglottis might be seen during mouth opening, but he did not determine its incidence (2). By a literature review, we found 42 easy and 3 difficult intubations reported (Table 1) (3–13). One of the difficult intubations and 15 of the easy intubations were males. Some of the case reports and letters do not even mention the weight of the patients. In these reports, age and gender are more emphasized, but we think that weight is as important as they are. Table 1 The ‘Mallampati zero’ cases in the English literature