The Clinical Anatomy of Cricothyroid Membrane, Its Relevance To Emergency Subglottic Procedures
Abstract
Precise anatomical knowledge is essential for successful emergency cricothyrotomy. However, most protocols assume that anatomical data from Western populations are universal. To address this, our study measured cricothyroid membrane dimensions in Nigerian adults and compared them with international standards. We analysed 148 cadaveric specimens (89 males, 59 females, aged 22–76) from three central Nigerian university anatomy departments between January 2023 and June 2024. Using digital callipers, vertical height, transverse width, and membrane thickness were measured at standardised locations. The researchers analysed the data using multiple linear regression in R 4.3.1, with demographic predictors. Compared to international standards, Nigerian specimens had lower vertical height (8.7±1.4 mm vs 9.8±1.2 mm; Cohen's d = −0.83, 95% CI: −1.00 to −0.66, p < 0.001), representing an 11.2% reduction. Membrane thickness was higher (4.3±0.8mm vs 2.8±0.6mm; Cohen's d = 2.09, 95% CI: 1.86–2.32, p<0.001), a 46.4% increase. Males had greater vertical height than females (9.2 mm vs 7.8 mm, p < 0.001). Ethnic differences were also observed, with Igbo specimens differing most from international norms. These significant morphometric differences indicate that Nigeria needs emergency airway protocols tailored to its population.
Keywords
Full Text:
PDFReferences
1. Bair, A. E., & Chima, R. (2015). The Inaccuracy of Using Landmark Techniques for Cricothyroid Membrane Identification: A Comparison of Three Techniques. Academic Emergency Medicine, 22(8), 908–914. doi: 10.1111/acem.12732
2. Prithishkumar, I. J., & David, S. S. (2009). Morphometric analysis and clinical application of the working dimensions of cricothyroid membrane in South Indian adults: With special relevance to surgical cricothyroidotomy. Emergency Medicine Australasia, 22(1), 13–20. doi: 10.1111/j.1742-6723.2009.01245.x
3. Develi, S., Yalcin, B., & Yazar, F. (2016). Topographical anatomy of the cricothyroid membrane and its relation with invasive airway access. Clinical Anatomy, 29(7), 949–954. doi: 10.1002/ca.22750
4. Kemper, M., Kleine-Brueggeney, M., Moser, B., Both, C. P., & Weiss, M. (2021). Dimensional compatibility of currently available equipment for cricothyroidotomy and adult airway anatomy: an in vitro analysis. British Journal of Anaesthesia, 127(3), 479–486. doi: 10.1016/j.bja.2021.05.022
5. Kristensen, Teoh, W., & Rudolph, S. (2016). Ultrasonographic identification of the cricothyroid membrane: best evidence, techniques, and clinical impact. British Journal of Anaesthesia, 117, i39–i48. doi: 10.1093/bja/aew176
6. Alerhand, S. (2018). Ultrasound for Identifying the Cricothyroid Membrane Prior to the Anticipated Difficult Airway. The American Journal of Emergency Medicine, 36(11), 2078–2084. doi: 10.1016/j.ajem.2018.07.027
7. Miglani, A., Miglani, S., Tawfik, H. M., & Drew, T. (2024). Both the extended neck position and insertion of a supraglottic airway device increase the height of the cricothyroid membrane in females. A prospective observational study. BJA Open, 13, 100364. doi: 10.1016/j.bjao.2024.100364
8. Kokulu, K., Alkan, E., Sert, E. T., Mutlu, H., Turkucu, C., & Akar, E. H. (2023). Determination of the cricothyroid membrane height by age and sex, and optimal tracheal tube size. The Laryngoscope, 134(4), 1825–1830. doi: 10.1002/lary.31102
9. Femi-Akinlosotu, O. M., Igado, O. O., & Adeniji, K. O. (2024). Morphometrics of human skulls and mandibles obtained from Southwestern Nigeria: implications in clinical manoeuvres. The Journal of Basic and Applied Zoology, 85(1). doi: 10.1186/s41936-024-00411-8
10. Fakorede, S. T., Adekoya, K. O., Fasakin, T. P., Odufisan, J. O., & Oboh, B. (2021). Ear morphology and morphometry as potential forensic tools for identifying the Hausa, Igbo, and Yoruba populations of Nigeria. Bulletin of the National Research Centre, 45(1). doi: 10.1186/s42269-021-00665-0
11. Ajmani, M. L. (1990). A metrical study of the laryngeal skeleton in adult Nigerians. Journal of Anatomy, 171, 187-191
12. Sprinzl, G. M., Eckel, H. E., Sittel, C., Pototschnig, C., & Koebke, J. (1999). Morphometric measurements of the cartilaginous larynx: An anatomic correlate of laryngeal surgery. Head & Neck, 21(8), 743-750.
13. Faul, F., Erdfelder, E., Lang, A., & Buchner, A. (2007). G*Power 3: A flexible statistical power analysis program for the social, behavioural, and biomedical sciences. Behaviour Research Methods, 39(2), 175–191. doi: 10.3758/bf03193146
14. Romanes, G. J. (1986). Cunningham's manual of practical anatomy (15th ed.). Oxford University Press.
15. Bennett, J. D., Guha, S. C., & Sankar, A. B. (2004). Cricothyrotomy: The anatomical basis. Journal of the Royal College of Surgeons of Edinburgh, 41(1), 57-60.
16. R Core Team. (2023). R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing. Retrieved from https://www.R-project.org/
17. Riederer, B. M. (2015). Body donations today and tomorrow: What is best practice and why? Clinical Anatomy, 29(1), 11–18. doi: 10.1002/ca.22641
18. Franklin, D., Freedman, L., & Milne, N. (2004). Sexual dimorphism and discriminant function sexing in indigenous South African crania. HOMO, 55(3), 213–228. doi: 10.1016/j.jchb.2004.08.001
19. Mounier, A., Villotte, S., Kacki, S., Mora, P., Espinasse, L., Dempawo, J. Z., Gerin, C., Meunier, Q., & Oslisly, R. (2024). Population affinities in pre‐colonial West Africa: The case of the burial cave Iroungou (Gabon, 14th–15th century CE). American Journal of Biological Anthropology, 185(2), 24997. doi: 10.1002/ajpa.24997
20. Franklin, D., Cardini, A., & Oxnard, C. E. (2009). A geometric morphometric approach to the quantification of population variation in sub‐Saharan African crania. American Journal of Human Biology, 22(1), 23–35. doi: 10.1002/ajhb.20908
Article Metrics
Metrics powered by PLOS ALM
Refbacks
- There are currently no refbacks.
Copyright (c) 2025 Olasoji O. Agboola, Thomas K. Adenowo
This work is licensed under a Creative Commons Attribution 4.0 International License.
Email the author