Morphometry Of The Thyroid And Cricoid Cartilages In Adults

Monica Jain, Usha Dhall

Maharaja Agrasen Medical College, Agroha (Hisar), Haryana

Abstract: Forty autopsy specimens of larynx (20 males, 20 females) in the age group 20 to 40 years, from Haryana were
subjected to morphometric analysis of thyroid and cricoid cartilages. A total of 29 measurements were taken to see normal
variation, sex differences and bilateral asymmetry. Except for thyroid angle and length of left inferior cornu, all the
measurements were more in males as compared to females. Mean thyroid angle was 85.25o+9.54o in males and
97.85o+10.35o in females. Thyroid lamina was placed more obliquely with respect to horizontal plane in females as compared
to males. Bilateral asymmetry, though present in majority of specimens, was insignificant. However, thyroid angle was
deviated to one or other side in 25 % specimens. A significant correlation was observed between height of individual and
length of thyroid lamina, height of cricoid arch and transverse diameter of cricoid cartilage.

Keywords: Thyroid cartilage, cricoid cartilage, morphometry, sexual dimorphism, asymmetry.

Introduction: larynx with the help of vernier caliper (to the nearest
The increasing application of sophisticated 0.1 mm) and goniometer. The cartilages were
electrophysiological, radiological and surgical weighed on a single pan electronic balance (sensitive
methods to the diagnosis and treatment of laryngeal to 0.01 gm.) after drying with blotting paper. In addition
disorders requires a profound knowledge of the size to weight, 27 other measurements were made after
and proportion of human larynx and its cartilaginous selecting unequivocal and well defined points (Fig. 1)
components. Recent interest in the condition of as follows: 1 and 2 - Length (height) of left & right
subglottic stenosis and post- intubational stenosis of thyroid lamina (maximum vertical distance from upper
the lower respiratory tract(Bishop, 1984) prompted us
Fig.1
to ascertain the measurements of laryngeal cartilages
.Although some information was available on the
dimensions of the human laryngeal cartilages in the
Western population, e.g. Europeon (Chievitz, 1882),
Italian (Balboni, 1955) German (Minigerode, 1955;
Eckel et al, 1994), Polish (Malinowski, 1967), North
Americans (Maue and Dickson, 1971) and Nigerians
(Ajmani, 1990), information in Indian population was
scanty (Longia and Saxena, 1980) (Harjeet and Jit,
1992). Hence the present work was done on the
morphometry of thyroid and cricoid cartilages in
autopsy specimens.

Material & Method :

Material used for the present study consisted
of larynges obtained from 40 adults (20 male, 20
female) varying in age from 20-40 years, on whom
medicolegal post mortem had been performed at
PGIMS Rohtak. Height of individuals was noted form
(E)
the records. The larynx was dissected together with
the trachea from the level of hyoid bone to the 2nd or 3rd Fig.1. Schematic drawings indicating the points of
measurements.
tracheal ring. The cartilages were cleaned of all the A and B - anterior view of thyroid and cricoid
extrinsic muscles and then separated very carefully cartilages.
C, D and E - posterior, lateral and superior view of
from each other. Measurements were taken on each thyroid cartilage respectively.
F and G - inferior and posterior view of cricoid
Correspondence to :- cartilage respectively.
Dr. Usha Dhall The numbers indicated are as per description in the
Sr. Prof. & HOD text.
Department of Anatomy, Maharaja Agrasen Medical College,
Agroha (Hisar), Haryana-125047 to lower border of lamina); 3 and 4 breadth of left &
Ph. : 01669-281174 right thyroid lamina (horizontal distance from
e-mail : ushadhall@rediffmail.com laryngeal prominence to the posterior margin of
J. Anat. Soc. India 57 (2) 119-123 (2008) 119
Morphometry Of The Thyroid And Cricoid .........................Monica Jain, Usha Dhall
lamina); 5 and 6 - Length of right & left superior cornu
(distance from tip to base); 7 and 8 - Length of right &
left inferior cornu (distance from tip to base); 9 - Depth
of superior thyroid notch (vertical distance from
highest level of laminae to the floor of the superior
thyroid incisure); 10 - Anterior thyroid height (distance
from upper to lower thyroid incisure); 11 and 12 -
Dorsal thyroid height (distance between tips of right &
left superior and inferior horns); 13 and 14 - Maximum
thyroid breadth at superior and inferior tubercle
(distances between two superior tubercles and two
inferior tubercles) respectively; 15 and 16 - Upper and
lower thyroid breadths (outer distances between
bases of superior and inferior cornua respectively
(from posterior aspect); 17 - Maximum breadth of
thyroid cartilage (Distance between posterior border
of lamina from the posterior aspect); 18 - Main height
of larynx (floor of the thyroid notch to lower margin of
cricoid cartilage); 19 - Thyroid Angle (angle between
the two thyroid laminae); 20 and 21 - Transverse
diameter of cricoid cartilage from outer and inner
aspect; 22 and 23 - Anterior-posterior diameter of
cricoid cartilage from outer and inner aspect; 24 and
25 - The thickness of cricoid cartilage at the level of
arch and lamina respectively; 26 and 27 - Height of
arch and lamina respectively; To evaluate
intraobserver error, measurements on 10 thyroid
cartilages were made 3 times by the first author at
intervals of two weeks. Analysis of variance showed
that intraobserver error was insignificant (p>0.05).
Observation:
1. Table I shows means of various measurements of
thyroid and cricoid cartilages in two sexes. Following
observations can be made:
i) Most important observation was that the
dimensions of thyroid cartilage particularly
the cornu and those of cricoid cartilage are
quite variable.
ii) All parameters of thyroid cartilage (except
thyroid angle and length of left inferior cornu)
and that of cricoid cartilage were higher in
males than in females. But the difference was
statistically significant only for weight of
thyroid and cricoid cartilages, length and
breadth of thyroid lamina, anterior thyroid
height and diameters of cricoid cartilage.
iii) Thyroid breadth decreases from cranial to
caudal side in both sexes and is maximum at
the level of superior tubercle. This obliquity
appears to be more in females as compared
to males.
J. Anat. Soc. India 57 (2) 119-123 (2008)
2. Asymmetry:
Bilateral asymmetry in the size of thyroid
lamina and cornu was seen in majority of
specimens but was not statistically
significant. However, in 25 % of cases the
thyroid prominence was not in median plane.
It was deviated either towards right (three
cases) or left side (seven cases). In one case
asymmetry was also associated with
asymmetry in direction of superior cornu.
3. Correlation with height:
A significant correlation (p<0.01) was
observed between following parameters of
thyroid and cricoid cartilages and height of
individual.
a. Length of thyroid lamina (male r=0.696,
t=5.96; female r=0.461 and t=3.20).
b. Transverse diameter of cricoid cartilage
(male r=0.576, t=4.34; female r=0.752,
t=7.03).
c. Height of arch of cricoid cartilage (male
r=0.719, t=6.38; female r=0.511, t=3.66).
Discussion :
The most interesting observation of the
present study is that there is wide individual variation
in most parameters of the thyroid and cricoid
cartilages. Maue and Dickson, 1971 also reported that
some measurements of thyroid cartilage showed
extreme variability while others were less variable.
Similar individual variations, though not reported, can
be observed from the published data of other workers
who conducted similar studies (Maue and Dickson,
1971; Ajmani et al, 1980; Zrunek et al, 1988; Ajmani,
1990; Longia, 1990 Eckel et al, 1994;). A significant
correlation was found between height of individual
and length of thyroid lamina, height of arch of cricoid
and transverse diameter of cricoid cartilage. Too-
Chung and Green (1974) reported that coronal and
sagittal diameter of cricoid cartilage had a linear
correlation with height. However, Ajmani et al (1980)
and Longia (1990) did not find any correlation
between the height of individual and the various
measurements of the thyroid and cricoid cartilages.
In general, all the measurements of thyroid
and cricoid cartilages were more in male than in
female except for the angle and length of left inferior
cornu which were more in female. The observation of
present study are consistent with those reported by
other workers (Maue and Dickson, 1971; Ajmani,
1990; Longia, 1990; Harjeet and Jit, 1992).
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Morphometry Of The Thyroid And Cricoid .........................Monica Jain, Usha Dhall

Table I: Parameters Of Thyroid And Cricoid Cartilage

S. PARAMETER MALE FEMALE STUDENT ‘t’ test
No. (mm.) Maxi. Mini. Mean S.D. Maxi. Mini. Mean S.D. p
1 Length of Left Lamina 31.5 22.6 27.5 2.9 30.0 18.8 22.7 3.8 <0.001
2 Length of Right Lamina 32.0 18.6 27.2 3.5 30.0 19.0 22.9 3.8 <0.001
3 Breadth of Left Lamina 44.0 25.0 36.8 4.8 41.6 23.8 30.0 6.5 <0.001
4 Breadth of Right 44.0 23.8 35.2 5.9 41.0 23.7 29.5 6.9 <0.01
Lamina
5 Length of Right 22.6 07.0 14.1 4.5 22.7 0.50 13.1 3.9 >0.05
Superior cornu
6 Length of Left Superior 24.3 09.0 15.1 3.5 22.7 08.7 13.5 3.3 >0.05
cornu
7 Length of Right inferior 13.6 06.0 08.0 1.6 10.5 03.0 07.2 2.3 >0.05
cornu
8 Length of Left inferior 09.0 05.5 07.1 0.9 1.16 05.0 07.6 1.9 >0.05
cornu
9 Depth of superior 17.0 0.70 11.2 2.7 16.0 06.0 09.7 2.7 >0.05
thyroid notch
10 Anterior thyroid height 21.6 12.0 16.4 2.7 21.0 10.0 13.4 3.2 <0.01
11 Dorsal thyroid height 47.6 20.0 38.8 6.9 46.6 25.0 34.0 6.3 >0.05
(Right side)
12 Dorsal thyroid height 54.3 29.5 36.2 5.7 50.0 27.0 35.1 6.7 >0.05
(Left side)
13 Maximum thyroid 54.5 35.0 45.5 5.6 57.3 35.0 42.0 5.8 >0.05
breadth at superior
tubercle
14 Maximum thyroid 37.8 22.0 29.6 4.1 36.4 20.8 26.9 5.2 >0.05
breadth at inferior
tubercle
15 Upper thyroid breadth 51.0 33.0 42.8 5.0 61.0 25.0 40.1 7.6 >0.05
(from post. aspect)
16 Lower thyroid breadth 42.5 26.0 35.1 4.6 43.0 08.7 32.3 4.9 >0.05
(from post.aspect)
17 Maximum breadth 49.0 22.0 38.7 5.9 42.0 28.7 34.9 4.5 >0.05
(between post.borders)
18 Main height of larynx 39.0 31.0 33.7 4.1 39.0 24.0 31.2 4.6 >0.05
19 Thyroid angle 90o 65o 85.25 9.54 118 o 85o 97.85 10.35 >0.05
20 Transverse diameter of 31.5 18.3 25.7 3.2 30.6 12.7 21.3 4.7 <0.01
cricoid cartilage (outer)
21 Transverse diameter of 29.0 12.0 17.2 3.6 26.0 10.5 15.7 4.4 >0.05
cricoid cartilage (inner)
22 Antero-posterior 36.0 14.7 28.6 4.9 32.8 18.0 23.2 4.1 <0.001
diameter of cricoid
cartilage (outer)
23 Antero-posterior 23.0 12.0 19.5 2.5 21.0 12.8 16.5 5.0 <0.02
diameter of cricoid
cartilage (inner)
24 Thickness of cricoid 5.0 2.0 3.1 0.84 4.7 2.0 2.8 0.7 >0.05
cartilage at the level of
arch
25 Thickness of cricoid 7.1 2.0 4.8 1.3 5.6 2.7 4.4 0.8 >0.05
cartilage at the level of
lamina
26 Height of cricoid arch 7.6 4.0 6.0 0.8 8.4 4.1 5.6 1.0 >0.05
27 Height of cricoid lamina 26.0 19.0 22.0 1.9 24.0 17.0 19.9 2.3 >0.05
28 Weight of Thyroid 12.00 2.20 6.87 2.56 9.30 2.30 4.38 2.30 <0.01
cartilage (gms)
29 Weight of cricoid 7.00 2.70 4.27 1.31 5.10 1.50 3.02 1.26 <0.01
cartilage(gms)

J. Anat. Soc. India 57 (2) 119-123 (2008) 121

Morphometry Of The Thyroid And Cricoid .........................Monica Jain, Usha Dhall

Table II : RACIAL DIFFERENCES IN THYROID AND CRICOID CARTILAGES (mean + S.D.)

Parameter Nigerians1 Germans6 Europeans5 North Americans 12 Indian7 Indian2 Indian

(mm.) (Present Study)
Male Female Male Female Male Female Male Female Male Female Male Female Male Female

37.92 35.25 27.40 22.20 26.22 19.75 29.20 24.60 27.50 22.70
Length of Lamina 25.30 19.30
+4.42 +3.10 +2.47 +2.85 +2.17 +1.17 +9.60 +6.00 +2.96 +3.71

34.89 32.17 41.90 31.20 37.82 28.27 29.60 26.20 36.80 30.00
Breadth of Lamina 41.90 30.20
+4.08 +4.27 +3.38 +2.73 +2.69 +1.82 +8.00 +4.90 +4.84 +6.50

Length of Superior 20.70 20.92 12.90 13.10 14.07 12.04 15.40 16.10 19.10 13.10
cornu +2.99 +3.01 +2.94 +2.35 +3.17 +2.23 +4.80 +4.70 +4.49 +3.95

T Length of Inferior 18.35 17.35 8.30 7.40 6.31 5.17 9.50 8.70 8.04 7.20
H cornu +3.11 +2.67 +1.27 +1.24 +1.39 +1.32 +4.00 +3.50 +1.60 +2.29
Y Depth of Superior 11.68 10.20 9.00 6.40 11.87 8.28 9.50 6.40 11.20 9.70
R Thyroid Notch +0.97 +0.51 +1.82 +1.33 +2.38 +1.36 +3.00 +2.50 +2.75 +2.73
O 89.92O 106.38O 78.13O 90.15O 78.70O 106.10 O 85.25 O 97.85 O
Thyroid angle
I +13.67 O +28.36O +11.60 O +10.36O +10.20O +14.40 O +9.54 O +10.35 O
D Anterior Thyroid 22.32 17.25 18.50 15.80 15.88 11.77 16.40 13.40
21.50 15.80 37.10 26.04
Height +7.38 +6.58 +2.54 +1.07 +1.74 +1.39 +2.66 +3.20

Dorsal Thyroid 44.82 37.25 43.90 36.00 38.96 30.40 38.80 34.00
49.00 45.50 45.50 38.90
Height +6.45 +7.47 +4.63 +3.84 +4.49 +2.67 +6.97 +6.34

Maximum Height of 45.06 38.08 34.60 28.20 30.70 31.20

40.60 32.70
Larynx +8.41 +8.25 +3.61 +2.62 +4.07 +4.60

29.84 25.84 26.40 21.40 22.00 18.30 17.20 15.70

C Transverse Diameter 21.40 15.90
+6.10 +3.48 +2.40 +2.04 +5.20 +5.20 +0.36 +0.44
R
Antero posterior 28.82 24.06 30.90 25.20 22.00 18.30 19.50 16.50
I Diameter +4.07 +2.53 +3.06 +2.33
20.70 16.00 16.03 16.43
+5.20 +5.20 +0.25 +0.50
C
26.50 24.60 24.60 21.30 20.00 19.30 22.00 19.90
O Height of Lamina
+6.30 +5.32 +1.84 +1.44
25.30 20.70 24.53 19.13
+6.20 +5.00 +0.19 +0.23
I
D 8.35 7.50 6.90 6.20 6.00 5.60
Height of arch 8.10 6.80 3.10 3.14
+4.30 +4.25 +1.35 +1.11 +0.08 +0.10

Another interesting new observation based Racial differences:

on beadth of thyroid lamina at superior and inferior
tubercles is that the thyroid laminae are more
obliquely placed in females not only with respect to
sagittal plane but also with horizontal plane. This
factor may also be contributing to greater thyroid
angle in females.
Asymmetry:
In the present study asymmetry in thyroid
angle was observed in ten specimens (25%) in which
angle was not in median plane. It was either deviated
towards right side (3 cases) or towards left side (7
cases). Hirano et al (1989) also reported asymmetry
in laryngeal frame work and suggested that it could be
due to handedness. But how handedness will result in
deviation of thyroid angle cannot be explained. It is
speculated that asymmetry in masticatory stresses
can result in such deviation and it would be worthwhile
studying this relationship.
Comparison of present observations in
Haryana population with other populations (Table II)
reveals that the absolute values differ greatly in
different populations which could be due to
differences in body built and racial differences.
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