ArticleJornal brasileiro de pneumologia : publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia2023
Tongue size matters: revisiting the Mallampati classification system in patients with obstructive sleep apnea.
Article in Jornal brasileiro de pneumologia : publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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4 citing papers in PubMed, 4 citations in OpenAlex.
- Point-of-Care Tongue Ultrasound for Perioperative Risk Stratification in Metabolic Bariatric Surgery.Obesity surgery · 2025Observational
- Anatomical Remodeling of the Upper Airway after Laparoscopic Sleeve Gastrectomy: A Multimodal Assessment of Structural and Functional Improvements in Obstructive Sleep Apnea.Obesity surgery · 2025Article
- The Obstructive Sleep Apnea Physical Exam: A Systematic Review and Meta-Analysis.Laryngoscope investigative otolaryngology · 2025Review
- Age- and Gender-Based Tongue Volume Variations on Asymptomatic Patients: A Simplified Approach to Form Baseline Data for Obstructive Sleep Apnea.Diagnostics (Basel, Switzerland) · 2025Article
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Authors and funding
6 authors at 2 institutions in 2 countries.
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No grant is acknowledged in the PubMed record.
Abstract
objectiveThe Mallampati classification system has been used to predict obstructive sleep apnea (OSA). Upper airway soft tissue structures are prone to fat deposition, and the tongue is the largest of these structures. Given that a higher Mallampati score is associated with a crowded oropharynx, we hypothesized that the Mallampati score is associated with tongue volume and an imbalance between tongue and mandible volumes.
methodsAdult males underwent clinical evaluation, polysomnography, and upper airway CT scans. Tongue and mandible volumes were calculated and compared by Mallampati class.
resultsEighty patients were included (mean age, 46.8 years). On average, the study participants were overweight (BMI, 29.3 ± 4.0 kg/m2) and had moderate OSA (an apnea-hypopnea index of 26.2 ± 26.7 events/h). Mallampati class IV patients were older than Mallampati class II patients (53 ± 9 years vs. 40 ± 12 years; p < 0.01), had a larger neck circumference (43 ± 3 cm vs. 40 ± 3 cm; p < 0.05), had more severe OSA (51 ± 27 events/h vs. 24 ± 23 events/h; p < 0.01), and had a larger tongue volume (152 ± 19 cm3 vs. 135 ± 18 cm3; p < 0.01). Mallampati class IV patients also had a larger tongue volume than did Mallampati class III patients (152 ± 19 cm3 vs. 135 ± 13 cm3; p < 0.05), as well as having a higher tongue to mandible volume ratio (2.5 ± 0.5 cm3 vs. 2.1 ± 0.4 cm3; p < 0.05). The Mallampati score was associated with the apnea-hypopnea index (r = 0.431, p < 0.001), BMI (r = 0.405, p < 0.001), neck and waist circumference (r = 0.393, p < 0.001), tongue volume (r = 0.283, p < 0.001), and tongue/mandible volume (r = 0.280, p = 0.012).
conclusionsThe Mallampati score appears to be influenced by obesity, tongue enlargement, and upper airway crowding.
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