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Median glossoepiglottic fold

The median glossoepiglottic fold is a midline mucosal fold that connects the posterior tongue to the anterior surface of the epiglottis. It forms the central part of the vallecula, the depression between the tongue base and epiglottis. This fold plays a crucial role in guiding food and liquids during swallowing and acts as an important anatomical landmark in laryngoscopy, intubation, and radiologic assessment. Accurate understanding of its anatomy, function, and imaging features is essential for radiologists, ENT surgeons, and anesthesiologists.

Synonyms

  • Midline glossoepiglottic fold

  • Median lingual-epiglottic fold

  • Central epiglottic fold

  • Vallecular fold

Function

  • Connects the posterior tongue to the epiglottis, forming the vallecula

  • Guides food and liquids during swallowing, helping prevent aspiration

  • Serves as a key landmark in endoscopy and intubation

  • Participates in the structural framework of the supraglottic larynx

MRI Appearance

T1-weighted images:

  • The median glossoepiglottic fold appears as a thin, linear soft tissue structure of intermediate signal intensity.

  • The air-filled vallecula and pharyngeal lumen appear as signal voids (black), sharply contrasting with the fold.

  • Surrounding musculature (posterior tongue and epiglottis base) is intermediate signal, while paralaryngeal fat is hyperintense.

  • Pathological lesions, such as edema or neoplasm, may appear hypo- to isointense and can enhance with contrast.

T2-weighted images:

  • The fold itself remains intermediate signal, while edema, inflammation, or cystic changes are hyperintense.

  • Air in the vallecula remains signal void, providing a clear anatomical outline.

  • Useful for evaluating subtle inflammatory or neoplastic changes in the supraglottic region.

STIR (Short Tau Inversion Recovery):

  • Fat suppression highlights pathological signal, while normal fold tissue remains low signal.

  • Edema or tumor appears bright hyperintense, making early pathology in the vallecula easily detectable.

  • Air within the vallecula continues to appear as signal void.

CT Appearance

  • On non-contrast CT, the median glossoepiglottic fold is soft tissue density and forms the midline mucosal ridge within the air-filled vallecula, which appears hypodense (black).

  • The epiglottis and tongue base are soft tissue density, providing contrast against the air-filled space.

  • Surrounding musculature and connective tissue are soft tissue density.

  • Pathology, such as mucosal thickening, tumors, or cysts, is seen as areas of soft tissue density within the normally air-filled vallecula.

  • CT is useful for assessing airway patency, masses, or pre-epiglottic space involvement.

MRI images

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