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Tracheal intubation in an adult male with Mallampati class zero airway

Fukuoka, Japan

To the Editor:

The modified Mallampati classification (class 1 = soft palate, fauces, uvula, and pillars seen; class 2 = soft palate, fauces, and uvula seen; class 3 = soft palate and base of uvula seen; and class 4 = soft palate not visible) has been used to predict the grade of laryngoscopic view before anesthesia.¹ Recently, Ezri et al. proposed the addition of a new airway class zero (the epiglottis is seen on mouth opening and tongue protrusion), and suggested that a class zero airway may be the easiest for tracheal intubation among the five airway classes.² Unfortunately, they failed to find any adult men with class zero airway in a series of 764 patients. To date, the existence of a class zero airway in adult men remains unclear. We recently observed the larynx in an adult male patient with a class zero airway.

A 25-yr-old man, 169 cm in height and 63 kg in weight, was scheduled for bilateral tonsillectomy for chronic tonsillitis. Routine oral examination revealed that he had a class zero airway (Figure). Anesthesia was induced with propofol. Three minutes after the iv injection of vecuronium 0.1 mg•kg^–1, the larynx was observed with a Macintosh blade 3 in the sniffing position. The laryngoscopic view according to Cormack and Lehane³ was grade 1, and his trachea was intubated without difficulty.

View larger version (150K): [in this window] [in a new window]   FIGURE Pharyngeal view in a man with a class zero airway (the epiglottis is seen).

References

1 Somsoon GL, Young JR. Difficult tracheal intubation: a retrospective study. Anaesthesia 1987; 42: 487–90.[Medline]

2 Ezri T, Warters RD, Szmuk P, et al. The incidence of class "zero" airway and the impact of Mallampati score, age, sex, and body mass index on prediction of laryngoscopy grade. Anesth Analg 2001; 93: 1073–5.[Abstract/Free Full Text]

3 Cormack RS, Lehane J. Difficult tracheal intubation in obstetrics. Anaesthesia 1984; 39: 1105–11.[Medline]

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				R. Mahajan and V. K. Grover Intubating conditions associated with the Mallampati "class zero" airway Can J Anesth, October 1, 2005; 52(8): 891 - 892. [Full Text] [PDF]

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