The Hyoepiglottic Ligament

NextGen Learning To Elevate Your Airway Practice

Introduction	Anatomy	Clinical View
Engagement	MedEd	What’s Next

This structure is so important we decided to give it it’s own page. The hyoepiglottic ligament is a fibrous band that connects the hyoid bone to the epiglottis, contributing to the structural support and coordination of movements during swallowing. The hyoid bone and its associated structures, including ligaments like the hyoepiglottic ligament, are important for the proper functioning of the upper respiratory and digestive systems. More importantly, knowledge of these structures and leveraging them for intubation is a critical skill in laryngoscopy.

Essential Anatomy

Here, we highlight the essential anatomy from the perspective of the intubator. As the tip of the laryngoscope blade moves around the base of the tongue and into the vallecula, the visible structure on the anterior surface of the epiglottis is the median vallecular (or glossoepiglottic) fold, not the hyoepiglottic ligament which sits just behind it.

Intubator’s View

In this series of images (going from left to right) the blade tip is advancing into the vallecula towards the median glossoepiglottic fold. Once the hyoepiglottic ligament behind it is properly engaged, the view of the glottis on the far right should appear.

Photos courtesy of Hennepin County Medical Center.

One of These Views is Better

Both views below clearly show the vocal cords, but these views are not equal—the view on the left results from advancing too deeply and too quickly. The epiglottis is not visible. Instead, it is pinned above the blade. While the vocal cords are clearly visualized, this close-up view at an acute angle can make tube delivery and tracheal access more difficult.

The view on the right shows a better view with proper engagement of the hyoepiglottic ligament, confirmed by the epiglottis being visible above the vocal cords. While a slightly less complete view of the cords may occur, this view provides more room to maneuver, and the approach angle is less acute, facilitating tube delivery.

Engagement of the Ligament

In this example, the median glossoepiglottic fold is visible just off to the left of the blade. Advancement of the blade partially engages the ligament but with a slight off-angle view.

Curated MedEd

This incredible resource is one of the best for essential airway skills. We suggest you dive into this page and add them to your learning network. We have them on ours.

Here is an example of what seating your blade in the vallecula and engaging the hyo-epiglottic ligament in the midline can do for your laryngeal view.

5Min airway

What’s Next

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