An abnormal epiglottis but an easy intubation

The Mallampatti test was devised as a simple bedside examination to predict the likelihood of difficult intubation. We would like to report a case of unusual anatomy seen when performing this test. The on-call anaesthetist was requested to provide anaesthesia for an otherwise healthy 33-year-old woman requiring an urgent Caesarean section. A Mallampatti test was performed as part of the pre-operative assessment and a 2-cm mass was immediately evident protruding from the base of the tongue. Closer inspection revealed this to be the patient's epiglottis (Figure). The patient received a general anaesthetic for the operation and was noted to be an extremely easy intubation. There were no intra- or postoperative complications. In their paper describing what has now come to be known as the Mallampatti test, Mallampatti et al. [1] printed an illustration of a Mallampatti Class 1 patient in whom the faucial pillars, soft palate and uvula are visible. The illustration also shows a small part of the epiglottis seen at the base of the tongue, although no mention is made of this in the text. We have been unable to find any case in the literature where an epiglottis is visible on performing a Mallampatti test, although there is a case report of an elongated epiglottis with an unusual angle causing a difficult intubation [2].