Morphological and Histologic Examination of the Epiglottis: Implications for Improving Epiglottic Closure Technique

Abstract

We conducted a histologic examination and measured the tension on the epiglottis to determine how dehiscence of the epiglottis can be prevented after epiglottic closure surgery. We classified configurations of the epiglottis into flat, intermediate, and omega types and studied the histology of each type. We also measured the tension in each of these 3 morphological types on 4 regions of the epiglottis (upper, middle, and lower points, and the cuneiform tubercle) at 3 different times: before incision, after median incision, and after reversed-Y incision. No histologic differences were evident among the epiglottic types. In the flat and intermediate types, the tension measured before incision decreased significantly upon completion of the median incision at every point. In these 2 types, the reversed-Y incision resulted in a further significant decrease in tension at the middle and lower points. In the omega type, the tension was low before incision and was not significantly reduced by either incision. We demonstrated that a median incision alone effectively decreased tension sufficiently to prevent dehiscence. The reversed-Y incision was even more effective for decreasing tension at the middle and lower points.