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Vallecula - Anatomy, Boundaries, Nerve Supply & Clinical Significance

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๐Ÿง  Vallecula - Anatomy, Nerve Supply & Clinical Significance

The vallecula is a small but clinically significant part of the pharyngeal anatomy.

Though often overlooked, it plays a key role in airway reflexes, transoral surgeries, and can be a common site of pathology and foreign body lodgement.


๐Ÿ“ What is the Vallecula?

The vallecula refers to cup-shaped depressions located between the base of the tongue and the anterior surface of the epiglottis.

  • There are two valleculae, one on either side of the median glossoepiglottic fold.

  • These depressions are visible during laryngoscopy, especially in intubation or endoscopic procedures.


๐Ÿงฉ Boundaries of Vallecula

BoundaryStructure
MedialMedian glossoepiglottic fold
LateralPharyngoepiglottic fold

๐Ÿง  Nerve Supply of Vallecula

NerveArea Supplied
Glossopharyngeal nerve (IX)Majority of the vallecula
Internal laryngeal nerveAnterior part of the vallecula

Which nerve is Internal Laryngeal nerve a branch of?


โš•๏ธ Clinical Importance of Vallecula

โœ… 1. Gag Reflex

  • Afferent limb: Glossopharyngeal nerve (IX)
  • Efferent limb: Vagus nerve (X) via pharyngeal branches
  • Clinical use: Testing gag reflex helps assess integrity of CN IX and X.

๐Ÿ’ก Note: Stimulation of vallecula during procedures (e.g., intubation) can trigger gagging indicating this pathway is intact.


โœ… 2. Airway Anesthesia & Awake Intubation

  • During awake fibreoptic intubation, internal laryngeal nerve is blocked by injecting local anesthetic through the thyrohyoid membrane.
  • This suppresses gagging and coughing, enabling smoother procedures.

โœ… 3. Foreign Body Lodgement

  • Due to its cup shape and location, the vallecula is a common site for foreign bodies like:

    • Fish bones
    • Food particles
  • Symptoms include:

    • Persistent foreign body sensation
    • Gagging, coughing, and choking
  • Often visualized using indirect or direct laryngoscopy.


โœ… 4. Vallecular Cysts & Lesions

  • Common site for:

    • Mucous retention cysts
    • Squamous cell carcinoma
  • Symptoms:

    • Foreign body sensation
    • Odynophagia (painful swallowing)
    • Voice changes (if internal laryngeal nerve involved)

๐Ÿง  Summary Points

  • Valleculae are cup-shaped spaces between the tongue base and epiglottis.
  • Bound by glossoepiglottic folds โ€“ median and lateral (pharyngoepiglottic).
  • Supplied by IX and X cranial nerves.
  • Clinically important for gag reflex, airway blocks, and as a site of foreign body and lesions.
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