title: Relationship between the internal laryngeal nerve and the triticeal cartilage: a potentially unrecognized compression site during anterior cervical spine and carotid endarterectomy operations.
abstract: OBJECTIVE
  The triticeal cartilage has received scant attention in the literature. To date, its relationship to the nearby internal laryngeal nerve has not been studied. Therefore, to elucidate further this anatomic relationship and its potential surgical implications, this study was performed.
  
  
  METHODS
  Eighty-six adult cadaveric sides underwent dissection of the internal laryngeal nerve near its penetration of the thyrohyoid membrane. The relationship of this nerve to the triticeal cartilage was documented. Measurements and histological analysis were performed on all cartilage specimens.
  
  
  RESULTS
  We identified triticeal cartilage in 51% of the specimens and found it to be hyaline in nature. The triticeal cartilage was located in the upper, middle, and lower thirds of the thyrohyoid membrane in 14%, 66%, and 20% of sides, respectively. Regardless of the position of the triticeal cartilage within the thyrohyoid membrane, the internal laryngeal nerve crossed directly over the triticeal cartilage on 59% of sides.
  
  
  CONCLUSIONS
  When present, the internal laryngeal nerve will cross over the triticeal cartilage in the majority of individuals. This relationship should be borne in mind during surgical manipulation in this area and when placing retractors during anterior neck operations including cervical discectomy/fusion and carotid endarterectomy. Compression of the internal laryngeal nerve against the solid triticeal cartilage can cause laryngeal nerve palsy and increase the risk of resultant postoperative aspiration.
authors.affiliation: Section of Pediatric Neurosurgery, Children's Hospital, Birmingham, Alabama 35233, USA.rstubbs@uab.edu
authors.forename: R Shane
authors.initials: RS
authors.lastname: Tubbs
authors.forename: Joshua F
authors.initials: JF
authors.lastname: Dixon
authors.forename: Marios
authors.initials: M
authors.lastname: Loukas
authors.forename: Mohammadali M
authors.initials: MM
authors.lastname: Shoja
authors.forename: Aaron A
authors.initials: AA
authors.lastname: Cohen-Gadol
mesh_terms: D000075202:Contraindications; D017586:Diskectomy / Q000009:adverse effects / Q000379:methods; D004210:Dissection; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D007817:Laryngeal Cartilages / Q000033:anatomy & histology* / Q000601:surgery; D061224:Laryngeal Nerve Injuries; D007823:Laryngeal Nerves / Q000033:anatomy & histology* / Q000601:surgery; D008297:Male; D009408:Nerve Compression Syndromes / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D019635:Neurosurgical Procedures / Q000009:adverse effects* / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D013525:Surgical Instruments / Q000009:adverse effects; D013957:Thyroid Cartilage / Q000033:anatomy & histology* / Q000601:surgery; D020421:Vagus Nerve Diseases / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control