Revisiting the Morphometry of Cricoid Cartilage and Vocal Folds

Abstract

Background: Rima glottidis and cricoid cartilage are important parts for laryngeal passage. However, their complex anatomical organizations give rise to occur some difficulties during intubation or surgeries. Therefore, these anatomical structures have great risk of damage during these procedures. The main aim of this study is to evaluate detailed morphometric properties of these critical parts of the larynx.

Methods: In this study, 74 female and 76 male patients’, without any pathology in their laryngeal and neck regions, computed tomography images were examined, retrospectively. Anteroposterior diameter of the supraglottic region immediately above the vocal folds, anterior angle of the vocal folds, transverse diameter of the rima glottidis and anteroposterior and transverse diameters of the cricoid cartilage were measured using Osirix-Lite version 9.

Results: Transverse diameter of the cricoid cartilage was found less than 1 cm, however, the transverse diameter of the rima glottidis was significantly smaller. All variables except for anterior angle of the vocal folds were higher in men than women.

Conclusions: The transverse diameter of the rima glottidis was the narrowest part of the laryngeal passage. The physicians should be aware of this part of the larynx besides the cricoid cartilage during endotracheal tube administrations.  

 

Keywords: Adult airway, computed tomography imaging, cricoid cartilage, larynx, vocal folds.

Keywords

• Adult airway,computed tomography imaging,cricoid cartilage,larynx

Plica vocalis ve cartilago cricoidea morfometrelerinin yeniden değerlendirilmesi

Abstract

Amaç: Rima glottidis ve cartilago cricoidea larynx geçişinin önemli kısımlarıdır. Bununla birlikte, karmaşık anatomik yapılar olmaları sebebiyle entübasyon veya cerrahi sırasında bazı güçlüklere yol açabilirler. Bu sebeple, bu işlemler sırasında, bu anatomik yapılar, istenmeyen yaralanmalar açısından oldukça büyük bir risk altındadırlar. Çalışmamızın amacı, larynx’in bu önemli parçalarının morfometrelerinin detaylı olarak incelenmesidir.

Materyal ve Metod: Bu çalışmada, larynx ve boyun bölgelerinde herhangi bir patoloji olmayan 74 kadın ve 76 erkek hastaya ait bilgisayarlı tomografi görüntüleri retrospektif olarak incelendi. Plica vocalis’in hemen üzerinde kalan supraglottic bölgenin anteroposterior çapı, plica vocalis’lerin anterior birleşme açısı, rima glottidis’in transvers çapı ve cartilago cricoidea’nın anteroposterior ve transvers çapları Osirix-Lite version 9 yazılımı kullanılarak ölçüldü.

Bulgular: Cartilago cricoidea’nın transvers çapı 1 cm'den az bulundu, ancak rima glottidis'in transvers çapı cartilago cricoidea’nın transvers çapından anlamlı derecede daha küçüktü. Plica vocalis’in anterior açısı dışındaki tüm değişkenler erkeklerde kadınlardan daha yüksekti.

Sonuç: Rima glottidis’in transvers çapı larynx geçişinin en dar kısmıydı. Endotrakeal tüp uygulamaları sırasında, uygulamayı yapacak olan hekimler cartilago cricoidea’nın yanı sıra larynx’in bu kısmının da farkında olmalıdır.

 

Anahtar Kelimeler: Erişkin solunum yolları, bilgisayarlı tomografi, cartilago cricoidea, larynx, plica vocalis.

Keywords

• Erişkin solunum yolları,bilgisayarlı tomografi,cartilago cricoidea,larynx,plica vocalis

References

1. 1. Glikson E, Sagiv D, Eyal A, Wolf M, Primov-Fever A. The anatomical evolution of the thyroid cartilage from childhood to adulthood: A computed tomography evaluation. Laryngoscope. 2017;127(10):E354-E8.
2. 2. Joshi M, Joshi S, Joshi S. Morphometric study of cricoid cartilages in Western India. Australas Med J. 2011;4(10):542-7.
3. 3. Sato M, Kayashima K. Difficulty in inserting left double-lumen endobronchial tubes at the cricoid level in small-statured women: A retrospective study. Indian J Anaesth. 2017;61(5):393-7.
4. 4. Sato M, Takesue M, Kayashima K. Difficult 32-Fr Double-Lumen Tube Intubation in a Small Japanese Woman With Narrow Transverse Width of the Cricoid Cartilage. A A Case Rep. 2016;7(7):150-1.
5. 5. Shiqing L, Wenxu Q, Jin Z, Youjing D. The Combination of Diameters of Cricoid Ring and Left Main Bronchus for Selecting the "Best Fit" Double-Lumen Tube. J Cardiothorac Vasc Anesth. 2018;32(2):869-76.
6. 6. Al-Mazrou KA, Abdullah KM, Ansari RA, Abdelmeguid ME, Turkistani A. Comparison of the outer diameter of the 'best-fit' endotracheal tube with MRI-measured airway diameter at the cricoid level. Eur J Anaesth. 2009;26(9):736-9.
7. 7. Denny M, McGowan RS. Sagittal Area of the Vocal Tract in Young Female Children. Folia Phoniatr Logo. 2012;64(6):297-303.
8. 15. Lima LER, Nita LM, Campelo VES, Imamura R, Tsuji DH. Morphometric Study on the Anatomy of the Fetal Cricoid Cartilage and Comparison Between Its Inner Diameter and Endotracheal Tube Sizes. Ann Oto Rhinol Laryn. 2008;117(10):774-80.

9. 9. Li G, Li H, Hou Q, Jiang Z. Distinct Acoustic Features and Glottal Changes Define Two Modes of Singing in Peking Opera. J Voice. 2018.
10. 10. Murray ESH, Michener CM, Enflo L, Cler GJ, Stepp CE. The Impact of Glottal Configuration on Speech Breathing. J Voice. 2018;32(4):420-7.
11. 11. Scheinherr A, Bailly L, Boiron O, Lagier A, Legou T, Pichelin M, et al. Realistic glottal motion and airflow rate during human breathing (vol 37, pg 829, 2015). Med Eng Phys. 2016;38(9):1035-.
12. 12. Mattei A, Magalon J, Bertrand B, Philandrianos C, Veran J, Giovanni A. Cell therapy and vocal fold scarring. Eur Ann Otorhinolaryngol Head Neck Dis. 2017;134(5):339-45.
13. 13. Seino Y, Allen JE. Treatment of aging vocal folds: surgical approaches. Curr Opin Otolaryngo. 2014;22(6):466-71.
14. 14. Wingstrand VL, Gronhoj Larsen C, Jensen DH, Bork K, Sebbesen L, Balle J, et al. Mesenchymal Stem Cell Therapy for the Treatment of Vocal Fold Scarring: A Systematic Review of Preclinical Studies. PLoS One. 2016;11(9):e0162349.
15. 16. Wani TM, Bissonnette B, Rafiq Malik M, Hayes D, Jr., Ramesh AS, Al Sohaibani M, et al. Age-based analysis of pediatric upper airway dimensions using computed tomography imaging. Pediatr Pulmonol. 2016;51(3):267-71.
16. 17. Wani TM, Rafiq M, Terkawi R, Moore-Clingenpeel M, AlSohaibani M, Tobias JD. Cricoid and left bronchial diameter in the pediatric population. Paediatr Anaesth. 2016;26(6):608-12.
17. 18. Rafiq M, Wani TM, Moore-Clingenpeel M, Tobias JD. Endotracheal tubes and the cricoid: Is there a good fit? (vol 85, pg 8, 2016). Int J Pediatr Otorhi. 2016;90:70-.
18. 19. Ajmani ML. A metrical study of the laryngeal skeleton in adult Nigerians. J Anat. 1990;171:187-91.
19. 20. Eckel HE, Sittel C, Zorowka P, Jerke A. Dimensions of the laryngeal framework in adults. Surg Radiol Anat. 1994;16(1):31-6.
20. 21. Harjeet, Jit I, Sahni D. Dimensions & weight of the cricoid cartilage in northwest Indians. Indian J Med Res. 2002;116:207-16.
21. 22. Jain M, Dhall U. Morphometry of the Thyroid and Cricoid Cartilages in Adults on Ct Scan. J Anat Soc India. 2010;59(1):19-23.
22. 23. Garbelotti Junior SA, Rocha PR, Liquidato BM, Marques SR, Arraez-Aybar LA, de Moraes LOC. Arch of cricoid cartilage anatomical variation: morphological and radiological aspects. Surg Radiol Anat. 2019.
23. 24. Seifpanahi S, Izadi F, Jamshidi AA, Shirmohammadi N. Effects of transcutaneous electrical stimulation on vocal folds adduction. Eur Arch Otorhinolaryngol. 2017;274(9):3423-8.