The cricoid cartilage , or simply cricoid (from the Greek ''krikoeides'' meaning "ring-shaped") or cricoid ring, is the only complete ring of
cartilage around the
trachea
The trachea, also known as the windpipe, is a cartilaginous tube that connects the larynx to the bronchi of the lungs, allowing the passage of air, and so is present in almost all air- breathing animals with lungs. The trachea extends from t ...
. It forms the back part of the
voice box and functions as an attachment site for muscles, cartilages, and ligaments involved in opening and closing the airway and in producing speech.
Structure
The cricoid cartilage sits just inferior to the
thyroid cartilage in the
neck, at the level of the
C6 vertebra, and is joined to it medially by the median
cricothyroid ligament and postero-laterally by the cricothyroid joints.
Inferior to it are the rings of cartilage around the trachea (which are not continuous – rather they are C-shaped with a gap posteriorly). The cricoid is joined to the first tracheal ring by the
cricotracheal ligament
The cricotracheal ligament connects the cricoid cartilage with the first ring of the trachea
The trachea, also known as the windpipe, is a cartilaginous tube that connects the larynx to the bronchi of the lungs, allowing the passage of air, and ...
, and this can be felt as a more yielding area between the firm thyroid cartilage and firmer cricoid.
It is also anatomically related to the
thyroid
The thyroid, or thyroid gland, is an endocrine gland in vertebrates. In humans it is in the neck and consists of two connected lobes. The lower two thirds of the lobes are connected by a thin band of tissue called the thyroid isthmus. The ...
gland; although the
thyroid isthmus is inferior to it, the two lobes of the thyroid extend superiorly on each side of the cricoid as far as the thyroid cartilage above it.
The
posterior part of the cricoid is slightly broader than the anterior and lateral parts, and is called the
lamina, while the
anterior part is the band; this may be the reason for the common comparison made between the cricoid and a
signet ring
A seal is a device for making an impression in wax, clay, paper, or some other medium, including an embossment on paper, and is also the impression thus made. The original purpose was to authenticate a document, or to prevent interference with a ...
. The slender ventral half, and the most caudal of the palpable laryngeal landmarks, is also referred to as the anterior cricoid arch.
Composition
It is made of
hyaline cartilage, and so can become
calcified
Calcification is the accumulation of calcium salts in a body tissue. It normally occurs in the formation of bone, but calcium can be deposited abnormally in soft tissue,Miller, J. D. Cardiovascular calcification: Orbicular origins. ''Nature Ma ...
or even
ossified, particularly in old age.
Function
The function of the cricoid cartilage is to provide attachments for the
cricothyroid muscle
The cricothyroid muscle is the only tensor muscle of the larynx aiding with phonation. It is innervated by the superior laryngeal nerve. Its action tilts the thyroid forward to help tense the vocal cords.
Structure
The cricothyroid muscle ...
,
posterior cricoarytenoid muscle and
lateral cricoarytenoid muscle muscles, cartilages, and
ligaments involved in opening and closing the
airway
The respiratory tract is the subdivision of the respiratory system involved with the process of respiration in mammals. The respiratory tract is lined with respiratory epithelium as respiratory mucosa.
Air is breathed in through the nose t ...
and in
speech production.
Clinical significance
When
intubating
Tracheal intubation, usually simply referred to as intubation, is the placement of a flexible plastic tube into the trachea (windpipe) to maintain an open airway or to serve as a conduit through which to administer certain drugs. It is frequentl ...
a patient under
general anesthesia prior to surgery, the
anesthesiologist
Anesthesiology, anaesthesiology, or anaesthesia is the medical specialty concerned with the total perioperative care of patients before, during and after surgery. It encompasses anesthesia, intensive care medicine, critical emergency medicin ...
will press on the cricoid cartilage to compress the esophagus behind it so as to prevent
gastric reflux from occurring: this is known as the
Sellick manoeuvre. The Sellick Manoeuvre is typically only applied during a Rapid Sequence Induction (RSI), an induction technique reserved for those at high risk of aspiration.
The Sellick maneuver was considered the standard of care during
rapid sequence induction
In advanced airway management, rapid sequence induction (RSI) – also referred to as rapid sequence intubation or as rapid sequence induction and intubation (RSII) or as crash induction – is a special process for endotracheal intubation that is ...
for many years. The American Heart Association still advocates the use of cricoid pressure during resuscitation using a
BVM, and during emergent oral endotracheal intubation. However, recent research increasingly suggests that cricoid pressure may not be as advantageous as once thought. The initial article by Sellick was based on a small sample size at a time when high tidal volumes, head-down positioning, and barbiturate anesthesia were the rule.
Cricoid pressure may frequently be applied incorrectly. Cricoid pressure may frequently displace the esophagus laterally, instead of compressing it as described by Sellick. Several studies demonstrate some degree of glottic compression reduction in tidal volume and increase in peak pressures. Based on the current literature, the widespread recommendation that cricoid pressure be applied during every rapid sequence intubation is quickly falling out of favor.
Gastric reflux could cause
aspiration if this is not done considering the general anesthesia can cause relaxation of the
gastroesophageal sphincter allowing stomach contents to ascend through the esophagus into the trachea.
A medical procedure known as a
cricoidectomy
A cricoidectomy is the surgical excision of the cricoid cartilage. The excision can often be performed under local anaesthetic and can either be partial or total. The procedure may be necessary as a treatment of pulmonary aspiration, to prevent p ...
can be performed in which part or all of the cricoid cartilage is removed. This is commonly done to relieve
blockages within the trachea.
[Michihiko Sonea1; Tsutomu Nakashimaa1; Noriyuki Yanagita (1995) "Laryngotracheal separation under local anaesthesia for intractable salivary aspiration: cricoidectomy with fibrin glue support" ''The Journal of Laryngology & Otology:Cambridge University Press'']
Fractures of the cricoid cartilage can be seen after
manual strangulation also known as throttling.
Additional images
File:Larynx detailed.jpg, Cricoid cartilage.
File:Illu larynx.jpg, Larynx
File:Gray950.png, The cartilages of the larynx. Posterior view.
File:Gray952.png, Ligaments of the larynx. Posterior view.
File:Gray953.png, Sagittal section of the larynx and upper part of the trachea.
File:Slide4e.JPG, Cricoid cartilage
See also
*
Tracheotomy
References
External links
Illustration at nda.ox.ac.uk* - "Skeleton of the larynx."
* ()
{{Authority control
Human head and neck