Epiglottic Vallecula Landmark for Intubation Illustration

Epiglottic Vallecula: A Key Landmark for Intubation (2024)

by | Updated: Dec 19, 2023

The epiglottic vallecula is an anatomic depression immediately beyond the base of the tongue that serves as an important landmark for endotracheal intubation.

This structure is located between the base of the tongue and the epiglottis, forming a small pocket that acts as a pathway for both food and air to pass through.

In this article, we will discuss the anatomy and physiology of the vallecula, including its structure, location, function, and clinical relevance.

What is the Vallecula?

The vallecula, derived from the Latin word “valles,” meaning “little valley,” is a small, depression-like structure found within the oropharynx.

The oropharynx is part of the pharynx, which is a muscular tube that connects the nasal and oral cavities to the larynx and esophagus.

Specifically, the vallecula is situated between the base of the tongue and the epiglottis, a flap-like structure that serves as a gatekeeper for the airways.

Laryngoscope into Vallecula Intubation Procedure Illustration

Structure and Location

The vallecula is an anatomical depression located in the upper part of the throat, at the base of the tongue. It is situated between the base of the tongue and the epiglottis, a cartilaginous flap that guards the entrance to the larynx (i.e., voice box).

The vallecula is divided into two distinct spaces known as the valleculae epiglotticae. These folds are created by mucous membrane-covered connective tissue and contain underlying minor salivary glands.

Though hidden from the naked eye, the vallecula plays a crucial role in the human body.

Its location allows it to trap saliva and occasionally food, preventing the swallowing reflex from being constantly triggered, especially during sleep.

Function

The primary function of the vallecula is to facilitate the swallowing process, known as deglutition. When food or liquid is ingested, the tongue pushes the bolus (i.e., chewed food mass) toward the back of the oral cavity.

As it reaches the vallecula, the epiglottis folds down, sealing off the larynx and ensuring the bolus moves into the esophagus instead of the trachea. This mechanism prevents choking and aspiration, protecting the airway during swallowing.

Clinical Relevance

The vallecula is an important anatomical landmark for healthcare professionals, particularly in airway management and endotracheal intubation.

During intubation, a tube is inserted through the mouth or nose and into the trachea to maintain a patent airway or facilitate mechanical ventilation.

The vallecula serves as a guide, allowing practitioners to properly position the laryngoscope blade, visualize the vocal cords, and subsequently insert the endotracheal tube.

Pathological Abnormalities

In some cases, abnormalities or pathologies affecting the vallecula can lead to dysphagia (i.e., difficulty swallowing), aspiration, or other complications.

Conditions such as tumors, inflammation, infections, or congenital deformities can impact the structure and function of the vallecula, resulting in the need for medical intervention.

Therefore, the early detection and appropriate treatment of these conditions can significantly improve patient outcomes and prevent further complications.

Moreover, the vallecula may be implicated in certain sleep disorders, such as obstructive sleep apnea (OSA). This occurs when the airway becomes partially or completely blocked during sleep, leading to disrupted breathing and reduced oxygen levels.

In some individuals, an enlarged tongue base or abnormalities in the vallecula may contribute to airway obstruction, and surgical interventions targeting these structures may help alleviate symptoms in selected cases.

FAQs About the Vallecula

Why is the Vallecula Important During Intubation?

During oral endotracheal intubation, a tube is inserted through the mouth and into the trachea to maintain an open airway and facilitate mechanical ventilation in patients who are unable to breathe on their own.

Identifying the vallecula is a key step in the process, as it allows the medical professional to safely navigate the laryngoscope blade past the base of the tongue, ultimately revealing the vocal cords and the entrance to the trachea.

By using the vallecula as a guide, the risk of trauma to the surrounding tissues is minimized, ensuring a more successful and less complicated intubation procedure.

What Causes Pooling in the Vallecula?

Pooling in the vallecula occurs when secretions, saliva, or other fluids accumulate in this depression-like structure in the oropharynx. This can be caused by factors such as dysphagia, which prevents efficient clearance of saliva or food from the oral cavity and pharynx.

Other contributing factors include:

  • Reduced saliva clearance due to neurological or muscular disorders
  • Dry mouth or xerostomia leading to thickened saliva
  • Infections or inflammation in the oropharynx
  • Impaired consciousness affecting the ability to swallow

Pooling in the vallecula can potentially result in complications such as aspiration, where pooled secretions are inhaled into the lungs, causing pneumonia or other respiratory issues. Addressing the underlying causes of pooling is essential to prevent these complications.

Is the Vallecula a Muscle?

No, the vallecula is not a muscle. It is a small, depression-like structure in the oropharynx formed by mucous membrane-covered connective tissue.

The vallecula is located between the base of the tongue and the epiglottis and plays a crucial role in the swallowing process and airway management. While surrounded by muscles in the oropharynx, it is not a muscle itself.

What is Mild Asymmetry in the Vallecula?

Mild asymmetry in the vallecula refers to a slight structural difference between the two valleculae epiglotticae, the spaces that form the vallecula. The vallecula is a small, depression-like structure in the oropharynx situated between the base of the tongue and the epiglottis.

It is divided into two distinct spaces, the valleculae epiglotticae, each formed by a median glossoepiglottic fold and a lateral glossoepiglottic fold.

In some individuals, these spaces may be slightly different in size, shape, or depth, resulting in mild asymmetry. This asymmetry is usually an incidental finding and typically does not cause any symptoms or issues related to swallowing or airway management.

However, if the asymmetry is a result of an underlying condition such as inflammation, infection, a mass or lesion, or congenital abnormality, it may warrant further evaluation and management by a healthcare professional.

Where is the Pyriform Sinus Compared to the Vallecula?

The pyriform sinus and the vallecula are both anatomical structures located in the pharynx, but they are found in different regions.

The vallecula is a small, depression-like structure situated within the oropharynx, the middle part of the pharynx. The pyriform sinus is located within the laryngopharynx, the lower part of the pharynx. Both play distinct roles in the swallowing process and are anatomically separate.

What is Leaf-Shaped and is Associated With the Vallecula?

The epiglottis is the leaf-shaped structure that is associated with the vallecula. The epiglottis is a flexible, flap-like cartilaginous structure located at the entrance of the larynx, the upper part of the windpipe.

It is covered by a mucous membrane and is attached to the thyroid cartilage and the base of the tongue.

Final Thoughts

The vallecula is a small yet essential structure in human anatomy, playing a crucial role in the swallowing process and airway management.

Understanding its anatomy, location, and function is vital for healthcare professionals, as it serves as an important landmark in various clinical procedures, including intubation.

Recognizing and addressing any abnormalities or pathologies affecting the vallecula can lead to better patient outcomes and overall health. While often overlooked, the vallecula is a vital component of the intricate and interconnected system that is the human body.

Written by:

John Landry, BS, RRT

John Landry is a registered respiratory therapist from Memphis, TN, and has a bachelor's degree in kinesiology. He enjoys using evidence-based research to help others breathe easier and live a healthier life.

References

  • Faarc, Kacmarek Robert PhD Rrt, et al. Egan’s Fundamentals of Respiratory Care. 12th ed., Mosby, 2020.
  • Jardins, Des Terry. Cardiopulmonary Anatomy & Physiology: Essentials of Respiratory Care. 7th ed., Cengage Learning, 2019.
  • Faiss KR, Naji A, Sharma S. Anatomy, Head and Neck, Trachea Epiglottic Vallecula. [Updated 2022 Jul 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022.

Recommended Reading