What is the vallecula?

What is the Vallecula

The vallecula (plural: valleculae) is a paired depression or pocket located at the base of the tongue, positioned between the tongue base and the lingual surface of the epiglottis, serving as a critical anatomical landmark in the oropharynx where food boluses temporarily collect before the swallowing reflex is triggered. 1, 2

Anatomical Definition and Boundaries

• The vallecula epiglottica represents a borderline area between the pharynx and the larynx, though it is covered by the epiglottis 3
• The borders of the vallecula within the oropharynx are defined by the anchoring systems of the epiglottic cartilage 3
• The basilingual margin (where the tongue base meets the vallecula) can sometimes be anatomically imprecise 3
• The valleculae are located at the level of the vocal cords when viewed during videofluoroscopic swallowing assessment 1

Functional Role in Swallowing

• The valleculae serve as a temporary collection point where the food bolus pools before the swallowing reflex is triggered 2
• During the oral phase of swallowing, delayed initiation of the swallow reflex can result in bolus material reaching the level of the valleculae or pyriform sinus 1
• Vallecular residue (food remaining in the valleculae after swallowing) is a common consequence of impaired tongue base retraction and reduced bolus propulsion force 2
• The vallecula plays a critical role in bolus control during the swallowing process 4

Clinical Significance

In Swallowing Dysfunction

• Residual material pooling in the valleculae after swallowing indicates impaired tongue base retraction 2
• Vallecular residue increases aspiration risk, particularly when surgical alteration of vallecular anatomy disrupts normal bolus flow patterns 2
• Videofluoroscopy can detect oral stasis and piecemeal swallowing (multiple swallows needed to clear a single bolus from the valleculae) 2
• The effortful swallow maneuver is specifically indicated for patients with clinically significant residue in the valleculae, as it increases tongue base retraction pressure 2

In Pathology

• The vallecula is a functionally strategic site and breeding ground for epidermoid carcinoma 3
• Vallecular cysts are rare causes of supraglottic obstruction causing stridor and swallowing difficulty, particularly in infants 5, 6
• Large vallecular masses can present as purely vallecular in location or as extensions from adjacent sites like the tongue base, lingual tonsils, or epiglottis 7
• When vallecular cysts occur in newborns, symptoms typically develop during the first week of life and include stridor, feeding difficulties, and respiratory distress 6, 8

Key Anatomical Relationships

• The vallecula has close proximity to the base of the tongue, which is the preferred area of extension for epitheliomas 3
• The hyoepiglottic membrane acts as a barrier for neoplastic infiltration in the vallecular region 3
• Pooling of secretions at the level of the vocal cords (indicated by "wet" vocal quality) correlates with vallecular dysfunction and increasing respiratory complications 1

Diagnostic Visualization

• Direct laryngoscopy is the gold standard for visualizing the vallecula and diagnosing vallecular pathology 8
• Flexible laryngoscopy or videofluoroscopy can visualize the exact location and size of vallecular masses 4
• It is critical to visualize the base of the tongue during any diagnostic endoscopic procedure when vallecular pathology is suspected 6