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Updated: Aug 30, 2025
Image Acquisition using Portable Sonography for Emergency Airway Management
Published on: September 28, 2022
Anatomic Characteristics of the Adolescent Cricothyroid Membrane on Computed Tomography Scans
Geoffrey S Kelly1, Aylin Tekes-Brady, Nathan Michael Woltman1
1From the Departments of Emergency Medicine.
Background:
The cricothyroid membrane (CTM) is the most important anatomic structure when performing emergency front-of-neck access (FONA) procedures. Adolescence is a period of rapid morphologic change in laryngeal structures, including the CTM. We hypothesized that the adolescent CTM would be sufficiently different from pediatric or adult anatomy to merit special consideration in FONA.
Objective:
The aim of the study was to define the procedurally relevant CTM anatomy in an adolescent population.
Methods:
This was a retrospective, multicenter cohort study composed of patients who underwent a diagnostic computed tomography scan during routine clinical care. Inclusion criteria were ages 16 to 19 years and a computed tomography of the neck with or without contrast. The primary outcome was CTM height measured in the midsagittal plane using electronic calipers.
Results:
One hundred thirty-four imaging studies met inclusion criteria. The average CTM height was strongly associated with age and ranged between 5.4 and 6.2 mm in male adolescents and 4.6 and 5.8 mm in female adolescents. We predicted that standard cuffed endotracheal and tracheostomy tubes recommended for FONA procedures (5.0- and 6.0-mm devices) could potentially fail for most patients in our cohort.
Conclusions:
The adolescent CTM is smaller than previously recognized. We recommend having a variety of equipment sizes readily available at any site where airway management in adolescents may occur.
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