Vallecula - Anatomy, Boundaries, Nerve Supply & Clinical Significance
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๐ง 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.
๐ 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.
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There are two valleculae, one on either side of the median glossoepiglottic fold.
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These depressions are visible during laryngoscopy, especially in intubation or endoscopic procedures.
๐งฉ Boundaries of Vallecula
Boundary | Structure |
---|---|
Medial | Median glossoepiglottic fold |
Lateral | Pharyngoepiglottic fold |
๐ง Nerve Supply of Vallecula
Nerve | Area Supplied |
---|---|
Glossopharyngeal nerve (IX) | Majority of the vallecula |
Internal laryngeal nerve | Anterior part of the vallecula |
Which nerve is Internal Laryngeal nerve a branch of?
โ๏ธ Clinical Importance of Vallecula
โ 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.
๐ก Note: Stimulation of vallecula during procedures (e.g., intubation) can trigger gagging indicating this pathway is intact.
โ 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.
โ 3. Foreign Body Lodgement
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Due to its cup shape and location, the vallecula is a common site for foreign bodies like:
- Fish bones
- Food particles
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Symptoms include:
- Persistent foreign body sensation
- Gagging, coughing, and choking
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Often visualized using indirect or direct laryngoscopy.
โ 4. Vallecular Cysts & Lesions
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Common site for:
- Mucous retention cysts
- Squamous cell carcinoma
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Symptoms:
- Foreign body sensation
- Odynophagia (painful swallowing)
- Voice changes (if internal laryngeal nerve involved)
๐ง 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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