The pre-epiglottic space is the fat-filled triangular compartment anterior to the epiglottis, bounded anteriorly by the thyroid cartilage and the thyrohyoid membrane, posteriorly by the epiglottis and its mucosa, and superiorly by the hyoepiglottic ligament. It connects laterally with the paraglottic spaces. It is an important pathway for supraglottic laryngeal carcinoma spread from the epiglottis anteriorly.
The pre-epiglottic space is the primary route of anterior invasion from supraglottic laryngeal carcinoma, explaining why tumours that appear to be limited to the epiglottis on endoscopy may involve the thyroid cartilage or cross to the opposite side via this space. CT and MRI demonstrate pre-epiglottic space fat replacement by tumour. Total laryngectomy removes the pre-epiglottic space en bloc; supraglottic laryngectomy must clear the pre-epiglottic fat as a resection margin. The space is routinely accessed in open supraglottic approaches through the thyrohyoid membrane.
Epiglottic carcinoma invading the pre-epiglottic fat is visible on CT as replacement of the normal fat density with tumour, indicating extension beyond the mucosal surface and influencing the decision between supraglottic and total laryngectomy; bilateral pre-epiglottic space involvement indicates that supraglottic partial laryngectomy margins may be inadequate.
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