Head and Neck Imaging

Epiglottic tilt, asymmetrical

The epiglottic tilt during swallowing appears to occur in two stages. The tilting towards a horizontal position is probably a passive movement, caused by elevation of the hyoid bone. The movement towards the inverted position is probably achieved by the contraction of the thyroepiglottic muscles. In a number of patients, this epiglottic movement is incomplete or asymmetrical. During a swallowing study, an asymmetrically tilted epiglottis may divert the contrast medium to one pyriform sinus, sometimes creating in the opposite pyriform sinus an image resembling the lacunar defect of a mass lesion. Asymmetrical tilting may be caused by mechanical interference with the epiglottic movement, such as is caused by large cervical osteophytes, but also by pharyngeal cancer immobilizing the epiglottis.

RH