Histology of the cricothyroid membrane: a clinical perspective

Abstract

Puncture of the cricothyroid membrane is a component of several clinical procedures. Among the several complications are the immediate risk of bleeding, long-term risk of subglottic stenosis and hoarseness of voice. Presence of blood vessels in the cricothyroid membrane has also been implicated in the extra-laryngeal spread of laryngeal cancers. Though various authors have described the attachments of the cricothyroid membrane, very few have studied its histology. We studied the histology of the cricothyroid membrane using hematoxylin and eosin, Mallory's trichrome and Verhoeff's special stain. The cricothyroid membrane was found to be continuous on its deeper aspect with the mucosa of the subglottic larynx and lined by pseudostratified ciliated columnar epithelium. The membrane was observed to be fibroelastic, containing equal proportions of collagen and elastic fibers and numerous fibroblast nuclei. Numerous blood vessels are seen traversing through the membrane, which probably connect intralaryngeal with other extralaryngeal vessels. These histological findings help to further understand the complications of cricothyroidotomy and spread of laryngeal cancer.

Keywords: Cricothyroid membrane; Histology; Subglottic stenosis.

Fig. 1

a and b Shows H/E stain of cricothyroid membrane. Note the ventral dense arrangement of fibers. Common for all figures (A pseudostratified columnar epithelium, B glandular tissue, C Blood vessels, D ventral dense connective tissue)

Fig. 2

a and b Shows Verhoeffs stain specific for elastin at 4× and 10 × magnifications. Elastin fibrils stain black to blue black; Collagen fibrils stain red. Note the equal proportions of collagen and elastin fibers. c and d Shows Mallory’s trichrome stain (4× and 40×)—collagen fibrils are blue and elastin fibrils are pink or yellow