The cricothyroid membrane (conus elasticus anterior portion, or median cricothyroid ligament) is the midline fibroelastic membrane spanning from the superior border of the cricoid cartilage to the inferior border of the thyroid cartilage in the anterior laryngeal midline. It is palpable in the midline as the firm yielding structure between the thyroid cartilage notch (above) and the cricoid cartilage (below), covered only by thin skin, subcutaneous tissue, and the cricothyroid muscles laterally.
| Origin | Upper border of the cricoid arch in the midline |
|---|---|
| Insertion | Lower border of the thyroid cartilage in the midline |
Forms the anterior wall of the subglottic airway; provides the emergency airway access route between the thyroid and cricoid cartilages; serves as the structural membrane for the anterior subglottic larynx connecting the cricoid to the thyroid cartilages in the midline.
The cricothyroid membrane is the target for emergency front-of-neck access in cannot-intubate cannot-oxygenate (CICO) emergencies. The recommended scalpel-bougie-tube technique uses a horizontal stab incision through the membrane after palpating the thyroid notch and sliding down to the soft gap above the cricoid, then passing a bougie and a small cuffed tube. The small cricothyroid arteries (from the superior thyroid arteries) often cross its upper part, so the incision is made in the lower half. Needle cricothyrotomy gives only temporary oxygenation. A surgical cricothyrotomy is usually converted to a formal tracheostomy within a few days, because prolonged use risks subglottic stenosis.
In CICO airway emergency where intubation and mask ventilation have failed, surgical cricothyrotomy through the palpable cricothyroid membrane with a scalpel-bougie-tube technique provides rapid oxygenation.
Scarring at the cricothyroid level after prolonged cricothyrotomy causing progressive breathlessness and voice change, treated endoscopically or by open reconstruction.
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