The median cricothyroid ligament has a central tendinous thickening representing the conus elasticus — the fibroelastic cone extending from the vocal ligaments superiorly to the cricoid arch inferiorly. This tendinous central band is the structure incised in emergency cricothyrotomy.
The central tendinous band of the cricothyroid membrane is the thickest, most avascular portion and the preferred site for cricothyrotomy incision. It is palpated between the thyroid cartilage notch above and the cricoid arch below. The cricothyroid arteries cross superior to this tendinous band and should be avoided by placing the incision in the lower half of the membrane.
Subglottic stenosis at the cricothyroid tendon incision site from cricothyrotomy placed too superiorly, injuring the vocal cords, requiring endoscopic dilation or laryngotracheal reconstruction.
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