The mineralised epiglottis: a narrative review illustrated by an index case

Epiglottic mineralisation is an uncommon anatomical variant whose embryological, histological, epidemiological, imaging and clinical implications are incompletely synthesised in the literature. We provide a narrative review of these topics, illustrated by an index case of almost complete epiglottic mineralisation identified on CT angiography.

A case of incidentally detected epiglottic mineralisation on retrospective head-and-neck CT angiography was analysed using multiplanar reformations, maximum-intensity projections, bone-window images, and three-dimensional reconstructions. Measurements were obtained with calibrated workstation calipers and verified by two senior researchers in independent sessions.

In a 90-year-old man, almost complete mineralisation of the epiglottis involved the petiolus epiglottidis and extended through the infrahyoid portion (body and stalk) and the suprahyoid portion (body and base). The infrahyoid portion (body and stalk) measured 1.703 cm in height and the suprahyoid portion (body and base) 0.973 cm; the midline hyoid-epiglottis distance was 0.842 cm. The mineralised superolateral margins were 1.6 mm (right) and 1.4 mm (left) from the posterior pharyngeal wall; the unmineralised posterosuperior margin contacted it directly. No laryngeal-membrane mineralisation was identified.

Almost complete epiglottic mineralisation is an uncommon anatomical variant of the laryngeal inlet. Extensive epiglottic involvement, angulation of the hyoid-epiglottic complex, near-contact and contact with the posterior pharyngeal wall, and absence of laryngeal membrane mineralisation make this case relevant to swallowing biomechanics, airway assessment, and the differential diagnosis of supraglottic calcific densities.