The cricotracheal ligament is a ring-shaped fibroelastic membrane connecting the inferior border of the cricoid cartilage to the superior border of the first tracheal ring. It is analogous to the ligamentum flavum of the spine and maintains the continuity of the airway between the larynx and the trachea. The membrane allows slight longitudinal movement of the trachea during swallowing and head movements.
| Origin | Lower border of the cricoid cartilage |
|---|---|
| Insertion | Upper border of the first tracheal ring |
Connects the cricoid cartilage to the first tracheal ring, maintaining airway continuity and providing the fibro-elastic junction between the rigid cricoid and the more flexible first tracheal ring.
The cricotracheal ligament is the plane of division in laryngotracheal separation injuries from blunt neck trauma (clothesline injuries, dashboard injuries), which can be rapidly fatal from complete airway loss. The ligament is also the level of tracheal resection in laryngotracheal reconstruction and in subglottic stenosis surgery where a cricotracheal resection removes the narrowed subglottic segment. In tracheostomy, the cricotracheal junction is the superior limit of safe tracheal incision, as entry at or above this level risks subglottic injury and stenosis.
High-velocity blunt neck trauma (clothesline injury, dashboard injury) ruptures the cricotracheal ligament, separating the larynx from the trachea and producing complete airway loss requiring emergency surgical airway control through the tracheal stump in the neck wound or formal tracheostomy.
Fibrostenosis at the cricotracheal junction level from intubation injury or post-tracheostomy is treated by cricotracheal resection, removing the narrowed subglottis and first tracheal ring and anastomosing the trachea directly to the thyroid cartilage, requiring careful patient selection for this technically demanding procedure.
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