A Cross-sectional Study to Assess the Need for Standardisation of the Modified Mallampati and Friedman’s Scoring System

Introduction: The Modified Mallampati (MM) grading and Friedman’s Tongue Position (FTP) scores are two major scoring systems used to evaluate the oropharyngeal space. However, the current descriptions of performing these scores do not specify the route of breathing taken by the patient during the examination. The dynamic changes in the tongue and palate, in relation to the route of breathing, may contribute to the high interobserver variability in MM scoring. Aim: To explore the differences in MM scores and Friedman’s scores obtained during mouth breathing and nose breathing in order to standardise the scoring system. Materials and Methods: A community-based cross-sectional study was conducted at the Departments of Anaesthesiology and Community Medicine at Believers Church Medical College Hospital in Central Kerala, India between April 2022 and October 2022, on 702 adults. MM scores and FTP scores were recorded separately for each person during mouth breathing and nose breathing. Socio-demographic variables such as age, gender, and Body Mass Index (BMI) were also collected. The data was analysed using the Z-test for proportions. Results: The mean age of the study participants was 3.58±16.42 years. The majority of the participants were females (69.2%), and more than half (59%) were above 50 years of age. Out of the 135 participants with an MM Score-1 during mouth breathing, 99 (73.3%) had higher scores during nose breathing. For the 196 individuals with an MM Score-2 during mouth breathing, 87 (44.3%) had higher scores during nose breathing. Similarly, out of the 220 people with an MM score of -3 during mouth breathing, 106 (48.2%) had a Score-4 during nose breathing. A similar pattern was observed for the FTP scores. Conclusion: The present study demonstrates significant variability in MM and FTP scores obtained during oral and nasal breathing, highlighting the need to standardise the route of breathing during examination. The study suggests that advising patients to breathe through the mouth may relax the tongue and improve the predictive value of MM grading.