Pre-epiglottic space

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The pre-epiglottic space (PES) is a triangular fat-containing space between the epiglottis and hyoid bone.

This area is rich in lymphatics which drain from the supraglottic larynx to cervical nodes. As such, the PES is at high risk of involvement of oropharyngeal and supraglottic laryngeal carcinomas. Additionally, it is important in staging as invasion of the PES automatically raises the TNM staging to T3 in oropharyngeal and supraglottic laryngeal carcinomas. PES involvement necessitates more aggressive surgical treatments with higher morbidity such as supraglottic or total laryngectomy, in contrast to more conservative treatment such as local resection or radiation therapy which may be considered when the PES is not involved.

Gross anatomy

Boundaries
  • superior: hyoepiglottic ligament
  • anterior: thyrohyoid membrane, thyroid cartilage
  • inferior: thyroepiglottic ligament
  • posterior: epiglottis, quadrangular membrane

Radiographic features

MRI
  • preferred imaging modality for assessment of PES invasion (best evaluated on pre-contrast T1, where fat appears bright)
  • fat-rich T1 hyperintense region

Related pathology