Unveiling The Epiglottis Vallecula | The Hidden Guardian Of Your Airway 2024
The epiglottis vallecula structure and function
Epiglottis vallecula
The epiglottis vallecula is an important landmark that is used during trachea intubation and the function of epiglottis vallecula is collecting the saliva.
-Collection of saliva by the epiglottis vallecula is to prevent the swallowing reflex initiation.
-So epiglottis vallecula is considered as a trap for occasionally food and saliva.
-At night, when any person is asleep, the epiglottis vallecula collects the saliva and traps it so that the swallowing reflex isn’t constantly triggered.
-The epiglottis vallecula consists of a small depression lined with mucous membrane located at the base of the tongue, directly between the pharyngeal folds on either side of the median genioglossal fold.
-The epiglottis vallecula are paired spaces between the root of the tongue and the epiglottis anterior surface.
-Each epiglottis vallecula is bounded medially by the middle lingual-epiglottic fold, and laterally by the lingual-hyoepiglottic fold.
-The epiglottis vallecula can’t be seen by the naked eye because it is far back and is located deep at the root of the tongue.
The epiglottis vallecula structure and function
-Anatomically, the epiglottis vallecula is located between the larynx and the pharynx and thus helps define the transition from these regions.
-The median glossoepiglottic fold is the separation between the tongue base and the epiglottis and gives rise to the two epiglottis vallecula.
-The epiglottis vallecula and pyriform cavities together are called pharyngeal cavities.
-The anatomical location of the vallecula makes them ideally located to collect saliva and prevent the swallowing reflex when a person is lying down during sleep.
Clinical significance
-All healthcare workers and anesthesiologists need to know the vallecula location.
-The epiglottis vallecula is considered an important anatomical landmark during oral tracheal intubation.
-For direct laryngoscopy, anesthesiologists may use different blade options.
-The options of these blades are:
- Macintosh blade and this blade is placed in the vallecula
- The Miller blade and this one is placed over the superior tip of the epiglottis
–One difference between these devices is that the Macintosh blade is placed in the epiglottic vallecula but the Miller blade is placed over the upper end of the epiglottis.
-The ultimate goal with either blade is to reduce the visibility of the vocal cords by drawing the epiglottis anteriorly and opening the larynx. None of the laryngoscopy blades are considered superior and the selection of the appropriate blade for a particular patient is up to the provider’s discretion.
– The Miller blade is longer and can be used if the patient has a longer neck, has a flexible epiglottis, and has an anterior airway.
-If correct visualization of the vallecula is not achieved with the blade during intubation, the risk of failure of the intubation attempt is very high, and hypercapnia and hypoxia can lead to possible cardiac arrest.
-One should be trained in intubation using newer techniques such as the use of a sliding endoscope in which the larynx is visible directly on the screen and the endotracheal tube can be passed over the vocal cords easily.
-While using the Macintosh and Miller blades, one has to pull the base of the tongue forward to raise the epiglottis forward to see the vocal cords, and this technique can depend on the operator.
-But while using a glideslope, the person performing the intubation does not need to raise the base of the tongue as much.
What is the meaning of vallecula?
-The term vallecula is derived from the Latin word “valles” which means little valley.
-The vallecula is a depression-like structure that is found within the oropharynx.
The oropharynx is a muscular tube that links the naso-oral cavities to the larynx and the esophagus.
The epiglottis vallecula location
The epiglottis vallecula is located in the upper part of the throat (at the the tongue base).
The vallecula is situated between the epiglottis(which is a flap-like cartilage that guards the larynx entrance) and the base of the tongue.
Pathological abnormalities
-Some pathological abnormalities can affect the epiglottis vallecula and that will lead to dysphagia which means difficulty swallowing, aspiration, or any other complications.
-These complications may be infections, tumors, congenital deformities, or inflammation will affect the function of the epiglottis vallecula so there will be a need for medical intervention.
-These abnormalities need early detection and the proper treatment to avoid further complications.
-Furthermore, the epiglottis is involved in some sleep disorders, such as OSA(obstructive sleep apnea).
-This occurs when the airway becomes completely or partially blocked while a person is asleep, leading to disturbed breathing and decreasing oxygen levels.
In some individuals, enlargement of the base of the tongue or the presence of vallecula deformities may contribute to airway obstruction, so the patient will need surgical interventions targeting these structures to help relieve symptoms.
Pooling in the vallecula
–Pooling means the accumulation of saliva or any other secretions in the vallecula.
–Pooling in the vallecula can happen due to many factors such as dysphagia which means the prevention of efficient clearance of food or saliva from the oral cavity and the pharynx.
-Other factors can cause polling in the vallecula such as:
- Muscular or neurological disorders that lead to a reduction of saliva clearance
- Thickened saliva due to dry mouth
- Inflammation or infection in the oropharynx
- Problems with the consciousness that affect the ability to swallow
-Pooling in the vallecula can lead to complications such as aspiration.
-In aspiration, pooled secretions such as saliva are inhaled into the lungs, and that will lead to several respiratory problems such as pneumonia.
Summary
-The epiglottis vallecula is a small but essential structure in human anatomy, playing a critical role in swallowing and airway management.
-Understanding its anatomy, function, and location is very important for healthcare professionals, as it serves as an important landmark in various clinical procedures and intubation is one of them.
-Recognizing and treating any abnormalities or diseases affecting the vallecula can lead to better outcomes for the patient and overall health. -Although often overlooked, the vallecula is a vital component of the complex, interconnected system that is the human body.
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