The inverted‐V shape during transverse laryngeal ultrasonography for cricothyroid membrane localisation

Abstract

Inaccurate cricothyroid membrane localisation can result in cricothyroidotomy failure. Ultrasonography improves membrane localisation accuracy vs. palpation [1], but 1572

Clinical usefulness of transcutaneous laryngeal ultrasonography in otolaryngology practice during COVID-19 pandemic: a literature review

“…This stepwise approach involves the ultrasonographic identification of the trachea in the transverse plane, the rotation of the transducer to the longitudinal plane and the subsequent identification of the anterior parts of the tracheal rings and the cricothyroid cartilage [ 48 ]. Gadd et al [ 49 ] studied the transverse laryngeal ultrasonography for the identification of the inverted-V shapes of the thyroid cartilage which allows cricothyroid membrane localization. He proved that ultrasonography identified the inverted-V shapes of the thyroid cartilage images with high sensitivity, but with low specificity, potentially confusing membrane localization.…”

“…Specificity: 96.1% 6 Dedecjus [ 13 ] 2010 Poland Evaluation of vocal cords function Evaluation of the functionality of vocal folds before and after thyroidectomy 50 Sensitivity: 100%. Specificity: 95.7% 7 Desai [ 34 ] 2004 India Assessment of laryngeal cancer and other laryngeal lesions Assessment of laryngeal and laryngopharyngeal cancers 25 Identification of vocal cord mobility: 92%; thyroid cartilage invasion: 68%; extra-laryngeal spread: 16% 8 Dhoot [ 35 ] 2017 India Assessment of laryngeal cancer and other laryngeal lesions Assessment of thyroid cartilage invasion in laryngeal and hypopharyngeal cancers 62 Sensitivity: 98%; specificity: 75% 9 Gadd [ 49 ] 2018 Australia Ultrasound-guided cricothyroidotomy Cricothyroid membrane localization during ultrasound-guided cricothyroidotomy 80 Sensitivity: 80%. Specificity: 15% 10 Gambardella [ 10 ] 2020 Italy Evaluation of vocal cords function Preoperative evaluation of vocal cords function in patients candidates to thyroid surgery 396 Sensitivity: 96.8%.…”

Recommendations from the Brazilian Society of Anesthesiology (SBA) for difficult airway management in adults

“…Transverse laryngeal ultrasonography enables identifying inverted V-shape imaging of the thyroid cartilage with high sensitivity and interindividual agreement but with low specificity (i.e., inverted V-shape images were also viewed at the cricothyroid membrane level, potentially confounding its correct location). 16 …”