Transverse section through the neck at C6

Landmarks in relation to the cervical vertebrae

  • At C1, base of the nose and the hard palate
  • At C2, the teeth of a closed mouth
  • At C3, the mandible and hyoid bone
  • At C4, the common carotid artery bifurcates
  • From C4-5, the thyroid cartilage
  • From C6-7, the cricoid cartilage

Transverse section through C6

transversesectionC6

The thyroid covers the 2nd to 4th tracheal rings. When performing a surgical tracheostomy the isthmus of the thyroid is general displaced downwards by blunt dissection, through if this is not possible it may need to be divided. When performing a percutaneous dilatational tracheostomy the space between the 2nd and 3rd tracheal ring is usually chosen. Tracheostomy higher than this increases the risk of tracheal stenosis. The use of ultrasound to select puncture site to avoid aberrant midline vessels can make the procedure safer, but the use of bronchoscopic guidance is essential for a percutaneous approach.

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