Once the operator has crossed the decision point, a surgical airway is inevitable; patient outcome hinges on speed. To ensure success, one must be able to reliably identify landmarks and have a methodical, step-by-step approach.
Instead of using the tip of the index finger to feel for landmarks, palpate the laryngeal framework using the whole hand with what I call the “laryngeal handshake.”
The traditional method of finding the cricothyroid membrane relies on palpation of the thyroid prominence (Adam’s apple) and the gap between the lower thyroid cartilage and the cricoid ring. This works well in thin males but not when there is significant neck fat and musculature. In women, the thyroid lamina is smaller and has a shallower angle; there is no thyroid prominence (see Figure 1).
Female versus male external anatomy: The thyroid prominence is evident in the male, whereas the thyroid and cricoid have equal prominence in a female. [/caption]Instead of using the tip of the index finger to feel for landmarks, palpate the laryngeal framework using the whole hand with what I call the “laryngeal handshake”(see Figure 2).
The hyoid, thyroid, and cricoid form a rhomboid structure and move as a unit from side to side (see Figure 3).
Instead of feeling for the thyroid prominence, palpate the broad thyroid lamina. When the front of the neck does not give certainty of location, I have found that palpating the firm lamina of the thyroid and moving the whole laryngeal framework from side to side will consistently confirm the landmarks.
It does not take a lot of force to appreciate landmarks or rock the larynx side to side. Palpation of the laryngeal framework has been taught as a close combat technique (when used with maximum force) to perform a “tracheal choke” (see Figure 4).