What Is A Retroverted Epiglottis Unraveling The Mystery Behind This Rare Condition 2024
Retroverted epiglottis diagnosis
Retroverted epiglottis is a poor and rare condition; its clinical signs cannot be distinguished from other causes of airway obstruction and need specific diagnosis.
–Retroverted epiglottis is a rare condition that occurs when epiglottic cartilage doesn’t maintain its right position and flexes caudally and dorsally which causes obstruction of the rima glottidis and that means airway obstruction.
-Diagnosis of retroverted epiglottis needs meticulous airway examination and the right understanding of normal rima glottidis and epiglottic position.
-After talking about retroverted epiglottis and knowing what it is, let’s talk about epiglottis.
Retroverted epiglottis and what epiglottis is in 2024
What is epiglottis?
–The epiglottis is a leaf-shaped elastic cartilage that is covered with a mucus membrane.
-The epiglottis is small and attached to the entrance of the larynx.
-The epiglottis is also known as a laryngeal flap.
-The importance of epiglottis is preventing water and food from entering the trachea and the lungs as it remains open during breathing to allow the air into the larynx but it closes during swallowing to prevent entering of food into the lungs and that will force the food and water to go along the esophagus and reach to the stomach.
Where is the epiglottis located in the body?
-The epiglottis is just behind the tongue, above and in front of the larynx.
-There is a combination of muscles, ligaments, and mucous membrane along the base and the sides of the epiglottis while the top of the epiglottis is loose and able to move.
How does the epiglottis do its function in covering the larynx?
1- The epiglottis and hyoid bone ( the bone in the middle of the throat) move up and forward and that causes the back of the tongue to put pressure on the epiglottis.
2- The muscles and ligaments that keep the epiglottis in place react to the pressure that is coming from entering food and water so these muscles and ligaments pull on the epiglottis.
3- The push and pull action makes the loose end of the epiglottis flip backward so it covers the top of the larynx.
4- During each swallow, the loose end of the epiglottis swings up and down so it keeps food and water away from the larynx.
5- In between swallows, the epiglottis moves back to its original position to allow air to enter the larynx.
When retroverted epiglottis happens, epiglottis can’t perform its normal function.
How to take care of the epiglottis?
Here are some suggestions to take care of the epiglottis:
1-Avoiding drinking of very hot drinks.
2-Stop smoking as smoking may cause epiglottitis.
3-Try to protect yourself from any infection by avoiding people who are coughing or sneezing.
4-Good hygiene is very important to avoid infection.
Retroverted epiglottis diagnosis
-Retroverted epiglottis can be diagnosed in these ways:
- Direct laryngoscopic examination
- Fluoroscopic examination
- Video endoscopic examination of the larynx
-Loss of epiglottis concave structure can be observed in addition to the obstruction of the rima glottidis.
Retroverted epiglottis management
-There are 3 surgical options for the retroverted epiglottis treatment:
- Temporary epiglottopexy
- Permanent epiglottopexy
- Partial epiglottectomy
-Some scientists recommend performing a temporary epiglottopexy at first to evaluate the occurrence of dysphagia post-operatively and the respiratory function.
If the results were favorable, it could be followed by permanent epiglottopexy.
Temporary epiglottopexy:
-The first choice of retroverted epiglottis treatment is a temporary epiglottopexy.
-It consists of placing 1 to 4 matters of sutures (in non-resorbable and recordable suture material).
-These sutures connect the epiglottis lingual part to the base of the tongue while fixating the epiglottis in a horizontal position.
Permanent epiglottopexy:
-The second choice of retroverted epiglottis treatment is permanent epiglottopexy.
-A wedge-shaped part of the mucosa on the epiglottis lingual side and the tongue base is removed, followed by the placement of 1 to 4 mattress sutures or single interrupted sutures with or without epiglottic cartilage involvement.
Partial epiglottectomy:
–It is the third choice of retroverted epiglottis treatment.
-One centimeter of the epiglottis apex is resected, after which the rima glottidis remains patent if the epiglottis is retroverted.
-If recidivism occurs after the failure of epiglottopexy, this surgical technique is performed.
When other comorbidities are judged to be more important and treated in the first place, retroverted epiglottis can be also treated medically using sedatives, corticosteroids, antibiotics, and antitussives.
-Another disorder that happens to epiglottis than retroverted epiglottis is epiglottitis.
Epiglottitis
–Epiglottitis is swelling and inflammation of the epiglottis.
-This swelling blocks the airflow into the lungs and that can be fatal.
Symptoms of epiglottitis
In children
- Sore throat
- Fever
- Difficult swallowing
- Drooling
- high-pitched sound when breathing in
In adults
- Sore throat
- Fever
- Drooling
- Difficulty swallowing and breathing
- high-pitched sound when breathing in
Causes of epiglottitis
Infection
–The main cause of epiglottitis is Haemophilus influenzae type b.
-But it is now less common because of Hib vaccines.
-Some other viruses and bacteria cause epiglottitis:
- Streptococcus A, B, and C
- Streptococcus pneumoniae (pneumococcus)
- Staphylococcus aureus
Injury
It is a rare condition that physical injury causes epiglottitis.
But epiglottitis can be caused due to breathing in smoke from a fire or drinking very hot drinks.
Treatment of epiglottitis
1-Ensure breathing:
- Wearing an oxygen mask
- Intubation
- cricothyroidotomy in rare cases when there is an emergency airway
2-Treating infection:
- Broad-spectrum antibiotics
- Ceftriaxone is the drug of choice for epiglottitis which is a third-generation cephalosporin with broad-spectrum activity against gram-negative bacteria.
-The dose of ceftriaxone is 1 g once daily for adults.
-For children, you can give 50 mg/kg once daily.
-It is preferred to give ceftriaxone IV infusion or IV slowly and avoid the IM route.
-The IV treatment continues for 5 days at least and if the condition has improved, then the oral treatment can be tolerated.
3-Dexamethasone can be used in the treatment.
How long does epiglottitis last?
Most people recover within a week with prompt treatment.
Summary
Retroverted epiglottis is a condition that causes obstruction
of the airway because of epiglottis retroflexes.
At the end of the article, we hope we have discussed all that you need about retroverted epiglottis and epiglottic in general.
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