EDMUND PRIBITKIN, MD; JAMES ALBRIGHT, MD

PHILADELPHIA, PENNSYLVANIA

A bifid epiglottis is a rare congenital anomaly of the larynx. The epiglottis is thought to arise from the hypobranchial eminence and ventral ends of the third and fourth branchial arches beginning at 5 weeks' gestation. Controversy exists with regard to whether the hypobranchial eminence is of midline or bilateral origin. Several authors point to existence of a bifid epiglottis as prima facie evidence of a bilateral origin. We discuss the case of a 67-year-old woman presenting with hemoptysis and a bifid epiglottis. We review the medical literature regarding this anomaly. Although many patients remain asymptomatic throughout their lifetimes, individuals with extensive bifurcation typically present as infants with a history of feeding difficulties, aspiration, and stridor. These individuals experience obstrnctive symptoms due to the collapse of the flaccid epiglottic halves into the airway upon inspiration. We discuss the management of the bifid epiglottis in such patients. We conclude with a review of the embryology of the epiglottis and discuss its relevance to the development and spread of supraglottic carcinoma.