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The modified Mallampati classification is one of the accepted predictors of difficult airway. The lower classes are associated with easy and higher classes with more difficult airways [1]. Ezri et al. proposed the addition of a new airway class 0 (epiglottis seen on mouth opening and tongue protrusion), and suggested that class 0 be the easiest for tracheal intubation among the five classes [2]. We recently encountered such a class 0 airway in an adult female, and had a slightly different experience. A 38-year-old woman, height 170 cm and weight 55 kg, was scheduled for vaginal hysterectomy. On airway examination, the epiglottis was seen (Fig. 6) correlating with Mallampati class 0. General anaesthesia was induced with thiopental and vecuronium for neuromuscular blockade. Laryngoscopy was performed with Macintosh blade 3 in the sniffing position, and the laryngoscopic view was Cormack and Lehane grade 2.

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Figure 6.  View of oral cavity showing the epiglottis.

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The exact correlation of the Mallampati score with the difficulty of intubation is poor [3]. We think this is true even for class 0.

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