Modified Mondays: Stop glorifying the epiglottis
Swallow specialist probs: I am so annoyed by the epiglottis. It gets so much credit for the hard work of so many other swallowing structures and even gets headlined as THE swallowing structure by tons of medical laypeople. (If I had a dollar for every time I heard someone describe it as “This structure that flips down when you swallow and covers your windpipe.” Oh PUH-lease!!!) And it doesn’t even act on it’s own!!! Other things have to happen for it to even move!!!
Ahem. Now that I have calmed down a bit, let’s take a look at this video. This patient has a history of head and neck cancer and has had a partial glossectomy. There is very little base of tongue retraction, hyolaryngeal excursion and no epiglottic movement. (SEE!! It needs others to move it around!! Lazy!) Base of tongue retraction facilitates the backward and downward movement of the epiglottis during the swallow, while pharyngeal constriction compresses the end of the epiglottis to further invert. We also used to be taught that hyoid elevation was also responsible for the epiglottis, but some more recent research is showing us that is not the case.
The point is… when commenting, explaining, or documenting on the swallow physiology or a recommended plan of care, we really shouldn’t be saying things like “incomplete epiglottic inversion”, we need to cite WHY there is incomplete epiglottic inversion, just like we do with aspiration. We can’t recommend exercises for epiglottic deflection, any more than our PT friends would recommend exercises to move the pants of a patient with impaired leg mobility up and down. The epiglottis movement is just like pants movement-it’s an indicator that something is wrong, but not the problem itself.
See below for some links to more info!
Epiglottic inversion mini tutorial - YouTube
"Hidden in Plain Sight": A Descriptive Review of Laryngeal Vestibule Closure - PubMed (nih.gov)