I initiate the laryngeal handshake with my dominant right hand (see Figure 5). Ergonomically, I prefer to stand on the patient’s right side (at the thorax) so that when holding the scalpel, I can rest my cutting hand on the sternum. (We will address sternal stabilization in part two of this series.)
I started gently up high with the hyoid, using the thumb and index finger, under the angle of the mandible. Staying lateral to midline, slide down to the broad, firm, thyroid lamina. At this point, use the index finger to come to midline and palpate the thyroid prominence in men. Lower down is the inferior cornu of the thyroid, bilaterally overlapping the cricoid cartilage. This is the bottom of the rhomboid, below which are the softer tracheal rings. Using the firm lamina of the thyroid as a guide (and especially if the thyroid prominence is not felt) the index finger is brought midline to the cricothyroid membrane at the inferior aspect of the lamina. In men, the thyroid cartilage is always more prominent than the cricoid, but in women they often have equal prominence.
After performing the laryngeal handshake with the dominant hand, switch to the non-dominant hand and grab the same landmarks. Use the non-dominant hand to stabilize the larynx (on the thyroid lamina) with the index finger over the cricothyroid. The dominant hand holds the scalpel and is stabilized on the sternum. Sternal stabilization is needed to make a controlled incision. We address this in part two of this series.