The epiglottis is a flap in the throat that keeps food from entering the windpipe and the lungs. The flap is made of elastic cartilage covered with a mucous membrane, attached to the entrance of the larynx. It projects obliquely upwards behind the tongue and the hyoid bone, pointing dorsally. It stands open during breathing, allowing air into the larynx. During swallowing, it closes to prevent aspiration and forcing the swallowed liquids or food to go along the esophagus instead. It is thus the valve that diverts passage to either the trachea or the esophagus.
Posterior view of the larynx. The epiglottis is the most superior structure shown.
|Precursor||Hypopharyngeal eminence [unreliable source?]|
The epiglottis is one of nine cartilaginous structures that make up the larynx (voice box). During breathing, it lies completely within the larynx. During swallowing, it serves as part of the anterior of the pharynx.
The body of the epiglottis consists of elastic cartilage.
The entire lingual surface and the apical portion of the laryngeal surface (since it is vulnerable to abrasion due to its relation to the digestive tract) are covered by stratified squamous non-keratinized epithelium. However, some parts of the laryngeal surface, which is in relation to the respiratory system, has respiratory epithelium: pseudostratified, ciliated columnar cells and mucus secreting goblet cells.
A high-rising epiglottis is a normal anatomical variation, visible during an oral examination, which does not cause any serious problem apart from a mild sensation of a foreign body in the throat. It is seen more often in children than adults and does not need any medical or surgical intervention.
The epiglottis is normally pointed upward during breathing with its underside functioning as part of the pharynx. During swallowing, elevation of the hyoid bone draws the larynx upward; as a result, the epiglottis folds down to a more horizontal position, with its superior side functioning as part of the pharynx. In this manner, the epiglottis prevents food from going into the trachea and instead directs it to the esophagus, which is behind it. Swallowing with little to no aspiration of food can occur even when there is no epiglottis (such as when destroyed by disease).
Should food or liquid enter the windpipe due to the epiglottis failing to close properly, the gag reflex is induced to protect the respiratory system. The glossopharyngeal nerve sends fibers to the upper epiglottis that contribute to the afferent limb of the gag reflex. (The gag reflex is variable in people from a limited to a hypersensitive response.) The superior laryngeal branch of the vagus nerve sends fibers to the lower epiglottis that contribute to the efferent limb of the cough reflex. This initiates an attempt to try to dislodge the food or liquid from the windpipe. Gag reflex can be managed by behaviour therapy, cognitive behaviour therapy, herbal remedies, acupressure, acupuncture, prosthetic devices, anti-nausea drugs, sedatives, local or general anaesthetics. Performing dental treatment is challenging in patients who experience gag reflex.
In some languages, the epiglottis is used to produce epiglottal consonant speech sounds, though this sound-type is rather rare.
Inflammation of the epiglottis is known as epiglottitis. Epiglottitis is mainly caused by Haemophilus influenzae. A person with epiglottitis may have a fever, sore throat, difficulty swallowing, and difficulty breathing. For this reason, acute epiglottitis is considered a medical emergency, because of the risk of obstruction of the pharynx. Epiglottitis is often managed with antibiotics, racemic epinephrine (a sympathomimetic bronchodilator that is delivered by aerosol), and may require tracheal intubation or a tracheostomy if breathing is difficult. Behind the root of the tongue is an epiglottic vallecula which is an important anatomical landmark in intubation.
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