DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20182939

Surgical anatomy of cricothyroid membrane with reference to airway surgeries in North Indian population: a cadaveric study’

Viswanathan Anand, Harikesh Sharma, Ashwani Sethi, Satyanjaya Sahoo

Abstract


Background: Surgical cricothyroidotomy is used to rapidly gain entry into the subglottic airway by creating an opening in cricothyroid membrane. The size and position of cricothyroid membrane is variable depending on racial characteristics of the individual. Statistics regarding dimensions of cricothyroid membrane has been documented extensively in Caucasian race. This study aims to augment the meagre information available on the Indian population on this important part of upper airway.

Methods: Morphometric cadaveric analysis done in tertiary health care centre. 39 adult human cadaveric larynges were obtained for this study. Using electronic Vernier caliper, different dimensions of cricothyroid membrane and depth of subglottis were noted down in predesigned proforma in standard office software. Data obtained was collated and compared with existing literature.  

Results: The average dimensions of cricothyroid space and cricothyroid membrane were uniformly larger in males compared to females. Mean middle width F: 10.92±1.57 mm, M: 13.84±2.54 mm; mean height F: 7.26±1.82 mm, M: 9.61±1.86 mm; mean thickness F: 2.89±0.22 mm, M: 4.53±0.92 mm and mean subglottic depth F: 17.24±2.09 mm, M: 21.94±2.93 mm.

Conclusions: Inter specimen disparity was noted. As cricothyroid membrane is smaller in Indian population compared to Caucasian population, ET tubes size 3.0 to 5.0 in females and 4.0 to 6.0 in males are suggested for use for cricothyroidotomy. Oversized tubes are known to cause dysphonia, laryngeal damage and subglottic stenosis.


Keywords


Cricothyroid membrane, Cricothyroidotomy, Subglottis, Cadaveric study

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References


Gens DR. Surgical airway management. In: Tintinalli JE, Kelen GD, Stapczynski JS, eds. Emergency Medicine: A Comprehensive Study Guide. New York: McGraw Hill; 2004: 119–124.

Bennett JD, Guha SC, Sankar AB. Cricothyrotomy: the anatomical basis. J R Coll Surg Edinb. 1996;41:57–60.

Dover K, Howdieshe R, Colborn DL. The dimensions and vascular anatomy of the cricothyroid membrane: relevance to emergent surgical airway access. Clin Anat. 1996;9:291–5.

Beasley N. Anatomy of the larynx and tracheobronchial tree. In: Scott-Brown's Otorhinolaryngology, Head and Neck Surgery. 7th edition. Hodder Arnold: Edward Arnold, 2008: 2132.

Boon JM, Abrahams PH, Mering JH, Welch T. Cricothyroidotomy: a clinical anatomy review. Clin Anat. 2004;17:478–86.

Narrod JA, Moore EE, Rosen P. Emergency cricothyrotomy: technique and anatomical considerations. J Emerg Med. 1985;2:443–5.

Sise MJ, Shackford SR, Cruickshank JC, Murphy G, Fridlund PH. Cricothyroidotomy for long term tracheal access. A prospective analysis of morbidity and mortality in 76 patients. Ann Surg. 1984;200:13–7.

Prithishkumar IJ, David SS. Morphometric analysis and clinical application of the working dimensions of cricothyroid membrane in south Indian adults: With special relevance to surgical cricothyroidotomy. Emergency Med Australasia. 2010;22:13–20.

American Association of Clinical Anatomists. The clinical anatomy of several invasive procedures, Educational affairs committee. Clin Anat. 1999;12:43–54.

Vadodaria BS, Gandhi SD, Mclndoe AK. Comparison of four different emergency airway access equipment sets on a human patient simulator. Anaesthesia. 2004;59:73–9.

Develi S, Yalcin B, Yazar F. Topographical anatomy of cricothyroid membrane and its relation with invasive airway access. Clin Anat. 2016;29:949–54.

Sharon EM, Jerris RH. Cricothyrotomy and translaryngeal jet ventilation. In: James RR, Jerris RH, eds. Clinical Procedures in Emergency Medicine. Philadelphia: Saunders; 1998: 130.