This patient suffered from severe subglottic stenosis(grade Ⅳb). During partial cricotracheal resection, we cut through the cricothyroid membrane and the cricoid arch along the line from the lower edge of the thyroid cartilage to 5 mm of the inferior thyroid cartilage corner anteromedially. This can protect the cricothyroid joint, effectively protect the recurrent laryngeal nerve, and also support the airway. Strictly adhere to airway separation, avoid excessive separation of scars, and combine with reasonable postoperative management to achieve a safe extubation.
Humans ; Constriction, Pathologic/surgery* ; Trachea/surgery* ; Airway Extubation ; Laryngostenosis/surgery* ; Larynx/surgery* ; Cricoid Cartilage/surgery* ; Treatment Outcome

Cricoid Cartilage ; Cysts ; Humans ; Larynx ; Neck

BACKGROUND: We previously reported that percutaneous dilatational tracheostomy (PDT) can be safely performed 2 cm below the cricothyroid membrane without the aid of a bronchoscope. Although our simplified method is convenient and does not require sophisticated equipment, the precise location for tracheostomy cannot be confirmed. Because it is recommended that tracheostomy be performed at the second tracheal ring, we assessed whether patient characteristics could predict the distance between the cricothyroid membrane and the second tracheal ring. METHODS: Data from 490 patients who underwent three-dimensional neck computed tomography from January 2012 to December 2015 were analyzed, and the linear distance from the upper part of the cricoid cartilage (CC) to the lower part of the second tracheal ring (2TR) was measured in the sagittal plane. RESULTS: The mean CC-to-2TR distance was 25.26 mm (95% CI 25.02–25.48 mm). Linear regression analysis showed that the predicted CC-to-2TR distance could be calculated as −5.73 + 0.2 × height (cm) + 1.22 × sex (male: 1, female: 0) + 0.01 × age (yr) −0.03 × weight (kg) (adj. R² = 0.55). CONCLUSIONS: These results suggest that height and sex should be considered when performing PDT without bronchoscope guidance.
Airway Management ; Bronchoscopes ; Bronchoscopy ; Cricoid Cartilage ; Critical Care ; Female ; Humans ; Linear Models ; Membranes ; Methods ; Neck ; Regression Analysis ; Trachea ; Tracheostomy

STUDY DESIGN: Observational study. PURPOSE: To assess the correlational accuracy between the traditional anatomic landmarks of the neck and their corresponding vertebral levels in Southern Chinese patients. OVERVIEW OF LITERATURE: Recent studies have demonstrated discrepancies between traditional anatomic landmarks of the neck and their corresponding cervical vertebra. METHODS: The center of the body of the hyoid bone, the upper limit of the lamina of the thyroid cartilage, and the lower limit of the cricoid cartilage were selected as representative surface landmarks for this investigation. The corresponding vertebral levels in 78 patients were assessed using computed tomography. RESULTS: In both male and female patients, almost none of the anatomical landmarks demonstrated greater than 50% correlation with any vertebral level. The most commonly corresponding vertebra of the hyoid bone, the lamina of the thyroid cartilage, and the cricoid cartilage were the C4 (47.5%), C5 (35.9%), and C7 (42.3%), respectively, which were all different from the classic descriptions in textbooks. The vertebral levels corresponding with the thyroid and cricoid cartilage were significantly different between genders. CONCLUSIONS: The surface landmarks of the neck were not accurate enough to be used as the sole determinant of vertebral levels or incision sites. Intra-operative fluoroscopy is necessary to accurately locate each of the cervical vertebral levels.
Anatomic Landmarks ; Asian Continental Ancestry Group ; Cricoid Cartilage ; Female ; Fluoroscopy ; Humans ; Hyoid Bone ; Male ; Neck ; Observational Study ; Spine ; Thyroid Cartilage ; Thyroid Gland

PURPOSE: The purpose of this study was to determine the extent of safety of medial dissection of the thyroid gland along the trachea. Medial to lateral dissection of the thyroid gland along the trachea after early division of the isthmus has been known to be a useful technique in thyroid surgery, especially for difficult cases, but the risk of injury of the recurrent laryngeal nerve (RLN) has constrained thyroid surgeons from utilizing this technique to its full extent. METHODS: Distances of the laryngeal entry point (LEP) of 134 RLNs of 71 patients from the midline of the trachea, and some other anatomical distances, were measured intraoperatively. The relationships of the intraoperatively measured data with circumferences of the cartilaginous portion of the trachea (CCT) around LEP measured preoperatively by CT scan were evaluated. RESULTS: LEP was always located within 2 mm vertically from the horizontally extended line of the inferior border of the cricoid cartilage and was the closest point from the midline in the whole course of the RLN. The distance between LEP and the midline was very closely correlated with CCT measured on preoperative CT scan, and it can be accurately calculated with a regression equation; Distance between LEP and the midline = (0.42 × CCT) + (1.2 × sex) + 3.2 (mm) (sex: female=0, male=1; R2 = 0.85). CONCLUSION: Early division of the isthmus and dissecting the thyroid off the trachea to the calculated extent is a safe and effective procedure.
Cricoid Cartilage ; Humans ; Recurrent Laryngeal Nerve* ; Surgeons ; Thyroid Gland* ; Thyroidectomy ; Tomography, X-Ray Computed ; Trachea*

The paper describes a minimally invasive tracheostomy technique that uses an intercartilaginous incision without resection of the tracheal cartilage and discusses its feasibility. A total of 20 adult cadavers (13 males and 7 females) were included in this study. The distance from the arch of the cricoid cartilage to the thyroid isthmus, maximal displacement of the thyroid isthmus, number of tracheal rings underneath the thyroid isthmus, and maximally opened distance resulting from an intercartilaginous incision were measured. The mean distance from the arch of the cricoid cartilage to the thyroid isthmus was 21.4±5.0 mm. The thyroid isthmus mainly overlaid the 3rd and 4th tracheal rings. The mean maximal displacement of the thyroid isthmus was 9.0±2.8 mm. Minimally invasive tracheostomy via an intercartilaginous incision is a feasible technique. A skin incision 2 cm below the cricoid cartilage enables exposure of the thyroid isthmus and anular ligament between the 2nd and 3rd tracheal rings. The intercartilaginous incision allows sufficient space for the tracheostomy tube. An intercartilaginous incision without resection of a tracheal ring can be a good alternative tracheostomy technique, especially for patients who require transient tracheostomy.
Adult ; Cadaver* ; Cartilage ; Cricoid Cartilage ; Humans ; Ligaments ; Male ; Skin ; Thyroid Gland ; Tracheostomy* ; Tracheotomy

Pediatric airway management has been both an integral part of routine anesthesia practice and one of its greatest challenges. Traditionally, it has been thought that the pediatric larynx is funnel-shaped, with the narrowest portion being situated at the cricoid cartilage; the choice of endotracheal tube type, size and insertion depth has been based on this concept. Uncuffed endotracheal tubes have typically been advocated for children younger than 8 years. However, it has recently been determined that the pediatric larynx is conical-shaped, with the narrowest portion of the larynx being situated at the rima glottidis. Therefore, there has been a shift in pediatric airway management, and cuffed tubes have been used without significant differences in post-extubation complication rates. It is critical to use the appropriate type and size of endotracheal tube, as well as to ensure proper insertion depth and adequate visualization of airway structures. Here, we introduce and discuss the optimal type, size, and insertion depth of endotracheal tube, and compare direct and video laryngoscopy.
Airway Management ; Anesthesia* ; Child ; Cricoid Cartilage ; Glottis ; Humans ; Intubation, Intratracheal* ; Laryngoscopy ; Larynx ; Pediatrics

This study is aimed to measure the morphology of Korean cricoid cartilages. A total of 48 - 33 males and 15 females - cadavers were used in this study. When it comes to their average age, males were 70 years old (50 to 91 years old), and females were 74 years old (47 to 92 years old). For this study, anteroposterior diameter and transverse diameter of superior side, anteroposterior diameter of inferior side, height of arch and lamina, anterior and posterior thickness of cricoid cartilages were measured. Anteroposterior diameters of superior and inferior cricoid cartilage were 28.5, 18.78 mm in male, and 23.85, 15.97 mm in female, respectively. And transverse diameters of superior side were 17.19 mm in male and 13.36 mm in female. Heights of arch and lamina were 7.10, 22.33 mm in male and 5.72, 20.10 mm in female, respectively. Thickness of anterior arch and posterior lamina were 2.57, 2.83 mm in male and 2.22, 2.42 mm in female, respectively. As a result, most Korean male measurements were significantly longer than female measurements except the anterior and posterior thickness of cricoid cartilages. Moreover the majority of measurements were shorter than Nigerians or Europeans. However, they were very similar to American Indians' measurements. In conclusion this study stated above can be a valuable foundation for the research of Korean cricoid cartilages' anatomic structures and morphology.
Cadaver ; Cricoid Cartilage* ; Female ; Humans ; Male

Primary cartilaginous tumors of the laryngeal lesion are rare and it accounts for only 1% of laryngeal tumor pathology. They are most commonly located on the endolaryngeal surface of cricoid cartilage, and it is extremely rare to find them in vocal muscle lesion. In most cases, treatment of choice is based on surgical excision, and postoperative radiotherapy is typically recommended. We experienced a case of a 22-year-old young woman without underlying disease, presenting extraskeletal myxoid chondrosarcoma of vocal cord, especially in the vocal muscle. The patient underwent mass excision through suspension laryngoscope and radiation therapy.
Chondrosarcoma* ; Cricoid Cartilage ; Female ; Humans ; Laryngeal Muscles ; Laryngoscopes ; Larynx* ; Pathology ; Radiotherapy ; Vocal Cords ; Young Adult

BACKGROUND: It is important to understand the anatomical relationship of the internal jugular vein (IJV) to the common carotid arteries (CCAs) to avoid inadvertent arterial injury. This study used computed tomography (CT) to evaluate this relationship and the changes associated with simulated 30o body rotation (SR30) in Korean subjects. METHODS: A retrospective analysis of 81 healthy adult subjects was performed using CT during physical checkups between November 2012 and September 2013. Data on both the left and right side IJV and CCA were recorded at the level of the cricoid cartilage and analyzed. The CCA was used as a reference for estimating the IJV location; this was recorded as lateral, anterior, medial, or posterior, using a segmented grid. The degree of overlap was calculated as a percentage, and changes to the anatomic relationship and overlap percentage caused by SR30 were derived. RESULTS: Prior to simulating rotation, the IJV was lateral (54.3%), posterolateral (27.2%), anterolateral (17.9%), or anterior (0.6%) to the CCA. After SR30, their position moved significantly in the anterolateral direction (P = 0.000). The degree of overlap significantly increased from 42.0 to 91.4% after SR30 (P = 0.000). No significant difference was observed between results obtained on the right and left sides before or after SR30. CONCLUSIONS: Special attention should be paid to possible CCA puncture during IJV catheterization because head or body rotation may induce anterior shifting of the IJV location relative to the CCA as well as an increased degree of overlap.
Adult ; Carotid Artery, Common* ; Catheterization ; Catheters ; Cricoid Cartilage ; Head ; Humans ; Jugular Veins* ; Punctures ; Retrospective Studies