• Paediatric anaesthesia · Jan 2020

    The development of the cricoid cartilage and its implications for the use of endotracheal tubes in the pediatric population.

    • Shiqing Liu, Wenxu Qi, Xiaohui Zhang, and Youjing Dong.
    • Department of Anesthesia, Shengjing Hospital, China Medical University, Shenyang, China.
    • Paediatr Anaesth. 2020 Jan 1; 30 (1): 63-68.

    BackgroundThe rigid cricoid cartilage is functionally the narrowest portion of the larynx. There is some controversy over the shape of the pediatric cricoid cartilage in the transverse plane. It is important to understand the development of the cricoid cartilage so that endo-traceheal tubes can be used more safely.AimTo determine changes in the internal diameter and shape of the cricoid cartilage during development and explore the implications of those changes for the selection of ETT type and size for children.MethodsThe cervical computed tomography scans were reviewed in patients aged 1-20 years. After performing the multiplanar reconstruction and correcting the slant, the transverse and anteroposterior internal diameters of the inlet and outlet of the cricoid cartilage were measured, respectively. The angle between the arch and the lamina of the cricoid cartilage in the middle sagittal plane was measured. The ratios of transverse to anteroposterior diameter for the inlet and outlet of the cricoid cartilage were calculated, respectively.ResultsIn females, the internal diameters of the cricoid cartilage increased linearly with age. In males, the internal diameters of the cricoid cartilage exhibited a growth spurt during adolescence. The transverse diameter of the inlet was the smallest diameter of the cricoid cartilage, and the predicting formula of the transverse diameter of the inlet for children aged 1-12 was 0.4 × age (year) + 5.1, R2  = .758. The angle between the arch and lamina of the cricoid cartilage and the ratios of transverse to anteroposterior diameter correlated weakly with age.ConclusionThe transverse inner diameter of the inlet is the smallest diameter of the cricoid cartilage. The "funnel shape" of the cricoid cartilage remains unchanged during development. The outer diameter should be considered when selecting an endotracheal tube.© 2019 John Wiley & Sons Ltd.

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