Vallecula - Anatomy, Boundaries, Nerve Supply & Clinical Significance
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🧠 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.
📍 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.
🧩 Boundaries of Vallecula
| Boundary | Structure |
|---|---|
| Medial | Median glossoepiglottic fold |
| Lateral | Pharyngoepiglottic fold |
🧠 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?
⚕️ Clinical Importance of Vallecula
✅ 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.
💡 Note: Stimulation of vallecula during procedures (e.g., intubation) can trigger gagging indicating this pathway is intact.
✅ 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.
✅ 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.
✅ 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)
🧠 Summary Points
- Valleculae are cup-shaped spaces between the tongue base and epiglottis.
- Bound by glossoepiglottic folds – 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.
📝 All the topics and questions mentioned in this post are explained in detail in my ENT notes - built for exam success and clinical understanding. Get full access by purchasing the notes.