Morphometry of the thyroid cartilage, epiglottis and piriform sinus: An anatomical study

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Rai" }, { "@type": "Person", "name": "Chettiar Ganesh Kumar" }, { "@type": "Person", "name": "B.V. Murlimanju" }, { "@type": "Person", "name": "Mangala M. Pai" }, { "@type": "Person", "name": "Latha V. Prabhu" }, { "@type": "Person", "name": "Amit Agrawal" } ], "publisher": { "@type": "Organization", "name": "F1000Research", "logo": { "@type": "ImageObject", "url": "https://f1000research.com/img/AMP/F1000Research_image.png", "height": 480, "width": 60 } }, "image": { "@type": "ImageObject", "url": "https://f1000research.com/img/AMP/F1000Research_image.png", "height": 1200, "width": 150 }, "description": " Background The goal was to measure the piriform sinus, epiglottis, and thyroid cartilage in our sample population. Methods This study included 22 adult embalmed cadavers available in the Department of Anatomy. Dimensions were measured using a digital Vernier caliper. Results The mean height of the thyroid laminae was 27 ± 1.4 mm at the right side and 25.5 ± 1.4 mm at the left side. Mean width of the thyroid lamina was 27.1 ± 1.3 mm at the right side and 27.4 ± 0.9 mm at the left side. The mean thickness of thyroid cartilage was found to be 4.4 ± 0.4 mm and 3.9 ± 0.5 mm over the right and left sides. The mean length, width and thickness of the epiglottis were 29.1 ± 0.5 mm, 22.2 ± 0.6 mm and 2.6 ± 0.3 mm correspondingly. The height, width and thickness of the right piriform sinus were 25 ± 0.5 mm, 14.2 ± 0.5 mm and 12.6 ± 0.5 mm, the same parameters were 25.3 ± 1.3 mm, 15.1 ± 0.7 mm and 13.3 ± 0.4 mm for the left side. Conclusions The height and thickness of the thyroid cartilage were greater on the right side than on the left side (p<0.05). It was statistically observed that the width and thickness were greater on the left side than on the right side (p < 0.05). The data about the height, width and thickness of the thyroid cartilage, epiglottis and piriform sinus are essential during the laryngeal and other neck surgeries. They guide in the preoperative positioning, predicting the difficulty of intraoperative exposure and retractor pulling. " } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://f1000research.com/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://f1000research.com/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://f1000research.com/articles/13-115/v2", "name": "Morphometry of the thyroid cartilage, epiglottis and piriform sinus:..." } } ] } Home Browse Morphometry of the thyroid cartilage, epiglottis and piriform sinus:... ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Vadgaonkar R, Rai AR, Kumar CG et al. Morphometry of the thyroid cartilage, epiglottis and piriform sinus: An anatomical study [version 2; peer review: 2 approved, 1 approved with reservations] . F1000Research 2024, 13 :115 ( https://doi.org/10.12688/f1000research.144481.2 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Research Article Revised Morphometry of the thyroid cartilage, epiglottis and piriform sinus: An anatomical study [version 2; peer review: 2 approved, 1 approved with reservations] Rajanigandha Vadgaonkar https://orcid.org/0000-0001-5577-495X 1 , Ashwin R. Rai https://orcid.org/0000-0001-8574-1809 1 , Chettiar Ganesh Kumar 1 , [...] B.V. Murlimanju https://orcid.org/0000-0003-1248-8296 1 , Mangala M. Pai https://orcid.org/0000-0001-6995-5807 1 , Latha V. Prabhu 1 , Amit Agrawal https://orcid.org/0000-0002-3287-5448 2 Rajanigandha Vadgaonkar https://orcid.org/0000-0001-5577-495X 1 , Ashwin R. Rai https://orcid.org/0000-0001-8574-1809 1 , [...] Chettiar Ganesh Kumar 1 , B.V. Murlimanju https://orcid.org/0000-0003-1248-8296 1 , Mangala M. Pai https://orcid.org/0000-0001-6995-5807 1 , Latha V. Prabhu 1 , Amit Agrawal https://orcid.org/0000-0002-3287-5448 2 PUBLISHED 15 Apr 2024 Author details Author details 1 Department of Anatomy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India 2 Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, 462020, India Rajanigandha Vadgaonkar Roles: Project Administration, Supervision, Writing – Review & Editing Ashwin R. Rai Roles: Data Curation, Methodology, Writing – Review & Editing Chettiar Ganesh Kumar Roles: Data Curation, Writing – Review & Editing B.V. Murlimanju Roles: Formal Analysis, Writing – Original Draft Preparation, Writing – Review & Editing Mangala M. Pai Roles: Supervision, Writing – Review & Editing Latha V. Prabhu Roles: Supervision, Writing – Review & Editing Amit Agrawal Roles: Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS This article is included in the Manipal Academy of Higher Education gateway. Abstract Background The goal was to measure the piriform sinus, epiglottis, and thyroid cartilage in our sample population. Methods This study included 22 adult embalmed cadavers available in the Department of Anatomy. Dimensions were measured using a digital Vernier caliper. Results The mean height of the thyroid laminae was 27 ± 1.4 mm at the right side and 25.5 ± 1.4 mm at the left side. Mean width of the thyroid lamina was 27.1 ± 1.3 mm at the right side and 27.4 ± 0.9 mm at the left side. The mean thickness of thyroid cartilage was found to be 4.4 ± 0.4 mm and 3.9 ± 0.5 mm over the right and left sides. The mean length, width and thickness of the epiglottis were 29.1 ± 0.5 mm, 22.2 ± 0.6 mm and 2.6 ± 0.3 mm correspondingly. The height, width and thickness of the right piriform sinus were 25 ± 0.5 mm, 14.2 ± 0.5 mm and 12.6 ± 0.5 mm, the same parameters were 25.3 ± 1.3 mm, 15.1 ± 0.7 mm and 13.3 ± 0.4 mm for the left side. Conclusions The height and thickness of the thyroid cartilage were greater on the right side than on the left side (p<0.05). It was statistically observed that the width and thickness were greater on the left side than on the right side (p < 0.05). The data about the height, width and thickness of the thyroid cartilage, epiglottis and piriform sinus are essential during the laryngeal and other neck surgeries. They guide in the preoperative positioning, predicting the difficulty of intraoperative exposure and retractor pulling. READ ALL READ LESS Keywords endoscopy, morphometry, otorhinolaryngology, piriform sinus Corresponding Author(s) B.V. Murlimanju ( [email protected] ) Close Corresponding author: B.V. Murlimanju Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2024 Vadgaonkar R et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Vadgaonkar R, Rai AR, Kumar CG et al. Morphometry of the thyroid cartilage, epiglottis and piriform sinus: An anatomical study [version 2; peer review: 2 approved, 1 approved with reservations] . F1000Research 2024, 13 :115 ( https://doi.org/10.12688/f1000research.144481.2 ) First published: 19 Feb 2024, 13 :115 ( https://doi.org/10.12688/f1000research.144481.1 ) Latest published: 15 Apr 2024, 13 :115 ( https://doi.org/10.12688/f1000research.144481.2 ) Revised Amendments from Version 1 Based on the reviewer comments, the conclusions of this study were revised. The statistically significant difference was given for the comparisons of the height, width and thickness of the thyroid cartilage, epiglottis and the piriform sinus. The clinical implications of these measurements are given. The typographical error in the figure legend was corrected. Based on the reviewer comments, the conclusions of this study were revised. The statistically significant difference was given for the comparisons of the height, width and thickness of the thyroid cartilage, epiglottis and the piriform sinus. The clinical implications of these measurements are given. The typographical error in the figure legend was corrected. See the authors' detailed response to the review by Deise Maria Furtado de Mendonça and José Aderval Aragão READ REVIEWER RESPONSES Introduction The larynx is a complex organ for voice production and respiration, which is supported by a series of cartilages, membranes, muscles, and joints. They bring about movement of vocal cords with a considerable range of mobility. 1 Apart from the phonating mechanism, it also serves as a sphincter or watch dog of the lower respiratory tract. Knowledge of laryngeal anatomy is important for various professionals, such as phoniatricians, speech therapists, oncologists, and otorhinolaryngologists. Understanding the laryngeal framework is mandatory for constructing biomechanical models for voice disorders that require accurate laryngeal dimensions. The thyroid cartilage forms a bulky structure in front of the laryngeal wall that protects the highly vibrating vocal cords located directly behind it. Because of its strength and power of resistance, it provides valuable protection to the laryngeal architecture. It has two quadrilateral laminae that are fused anteriorly in the lower two thirds leaving a ‘V’ shaped laryngeal notch superiorly. The fused anterior borders form a subcutaneous thyroid angle (laryngeal prominence) that is more prominent in males than in females. Being a hyaline cartilage, its ossification is not uncommon to the extent that, in old age, the cartilage may fracture on lateral compression or may compress backward against the vertebral column, as in strangulation or hanging. Injury to this cartilage warrants immediate attention, as subsequent laryngeal edema may lead to respiratory impairment. 1 The epiglottis is shaped like a leaf, projecting into the lumen of the pharynx, posteroinferior to the tongue, and hyoid bone. It is an elastic cartilage belonging to the larynx. In animals, the epiglottis serves the additional function of olfaction as well. 2 It develops from the 4th pharyngeal arch. 3 , 4 There is scant information in the literature about the dimensions of the epiglottis in adults. However, cadaveric studies are scarce, particularly in the Indian population. The morphometric data of the epiglottis are clinically important as there are changes in the dimensions of the epiglottis in epiglottitis. Anatomically, the piriform sinus is a hidden area, the malignancies of which would initially cause fewer symptoms, and the patient often presents late to the hospital. It has richer lymphatic drainage, which drains into the jugulodigastric lymph nodes. Malignancy in the piriform sinus can cause distant metastasis with a higher frequency. The piriform sinus is a part of the hypopharynx; however, it is more studied along with the larynx. The piriform sinus is pear shaped space form the cavity of laryngopharynx along with the ventricle of larynx. 5 They are thought to add to the acoustic uniqueness of the voice. 6 However, they are important because of the capacity to store the food and liquid for the temporary period. 7 If there is any obstruction in the food passage, due to the irritation in the laryngopharynx, pooling of saliva occurs in the piriform fossa, which is known as ‘Jackson’s sign’. During food swallowing, particles such as chicken and fish bones could be impacted within the piriform sinus and may lead to dysphagia. This is an indication for endoscopic removal under general anesthesia. 8 The management of entrapped foreign bodies by endoscopic removal requires clinical training and skill. Inadvertent removal of the foreign body and inappropriate manipulation can cause injury to the internal laryngeal nerve, which is present deep in the piriform sinus. Injury to this nerve can cause anesthesia of the larynx above the level of the vocal cords, and may lead to the entry of food particles inside the larynx. If this continues, food particles may pass to the trachea and lungs, the accumulation of which can manifest as aspiration pneumonia. It has been reported that, the dimensions of piriform fossae have impact in the pitch of the voice particularly in the singers. 5 Due to all these implications, the anatomical knowledge of piriform sinus is essential to the anaesthesiologist and otorhinolaryngologist. Data on the dimensions of the thyroid cartilage, epiglottis, and piriform fossa are essential for anesthesiologists during laryngoscopy and endotracheal intubation. However, they are scarce in scientific literature. Few studies have measured the thyroid cartilage, piriform fossa, and epiglottis in our sample population. In this context, the goal of this study was to determine the dimensions of the thyroid cartilage, epiglottis, and piriform sinus in embalmed cadavers of an Indian sample population. Methods This anatomical study comprised of 22 adult embalmed human cadavers; the sample size was calculated as described in literature. 9 A digital Vernier caliper (Mitutoyo, Japan, 0-150 mm 500-196) was used to perform the measurements. height, width, and thickness of the thyroid cartilage, epiglottis, and piriform fossa were also measured. The measurements were taken at their maximum diameter, and for the thyroid cartilage and piriform fossa, readings were taken separately over the right and left sides. Specimens were excluded if there were any associated pathological changes. The data are presented as mean ± standard deviation, and the side-based comparison of the right and left sides was performed using the paired t-test. The most recent version of the SPSS (version 27) software was used for statistical analysis. Sex-based comparisons and age-wise segregation were not performed in the present study. The measurements performed in the thyroid cartilage, epiglottis of the larynx, and piriform fossa in the present study are shown in the represented diagrams ( Figures 1 , 2 , and 3 , respectively). Figure 1. Morphometry of the thyroid cartilage of larynx in the cadaveric specimen. a. Photograph of the ventral view of thyroid cartilage showing the measurement of height (AB) and width (CD); b. dorsal aspect of the thyroid cartilage showing the measurement of thickness (EF*). Figure 2. The cadaveric larynx showing the epiglottis. The measurements are represented as AB: length of the epiglottis, CD: width of the epiglottis, EF: thickness of the epiglottis. Figure 3. The cadaveric piriform sinus (PS). The measurements performed in this study are represented as AB: supero inferior diameter of the piriform sinus, CD: medio lateral diameter of the piriform sinus, EF: antero posterior diameter of the piriform sinus. This study was approved by the institutional ethics committee of our institution (Approval Committee Name: Institutional Ethics Committee, Kasturba Medical College, Mangalore, Approval Number: IEC KMC MLR: 02/2022/61, dated 17.02.2022). We confirm that written informed consent was obtained from the body donors to conduct medical research on their bodies upon death. The protocol for this anatomical study has already been published with the dx.doi.org/10.17504/protocols.io.x54v92m8ml3e/v1 . Results The morphometric data of the thyroid cartilage obtained in the present study are presented separately for the right and left sides in Table 1 . The mean height of the thyroid laminae was 27 ± 1.4 mm on the right side and 25.5 ± 1.4 mm on left side. The mean width of the thyroid lamina was 27.1 ± 1.3 mm on right side and 27.4 ± 0.9 mm on the left side. The mean thickness of thyroid cartilage was found to be 4.4 ± 0.4 mm and 3.9 ± 0.5 mm on right and left sides. The height and thickness were greater on the right side than on the left side. The difference was statistically significant (p0.05). The dimensions of the epiglottis obtained in this study are listed in Table 2 . The mean length, breadth and the thickness of the epiglottis were 29.1 ± 0.5 mm, 22.2 ± 0.6 mm and 2.6 ± 0.3 mm respectively. Table 1. Sidewise comparison of the morphometric data of the thyroid lamina (n=22). Dimension Right side (n=22) Left side (n=22) Height * 27 ± 1.4 mm 25.5 ± 1.4 mm Width 27.1 ± 1.3 mm 27.4 ± 0.9 mm Thickness * 4.4 ± 0.4 mm 3.9 ± 0.5 mm * Significance, p > 0.05. Table 2. Morphometric data of the epiglottis (n=22). Epiglottis Mean ± standard deviation Length 29.1 ± 0.5 mm Width 22.2 ± 0.6 mm Thickness 2.6 ± 0.3 mm The dimensions of the piriform fossa obtained in the present study are given separately for the right and left sides in Table 3 . The height, width and thickness of the right piriform sinus were 25 ± 0.5 mm, 14.2 ± 0.5 mm and 12.6 ± 0.5 mm respectively. The same parameters were 25.3 ± 1.3 mm, 15.1 ± 0.7 mm and 13.3 ± 0.4 mm for the left side. It was statistically observed that the width and thickness were greater on the left side than on the right side (p 0.05). Table 3. Dimensions of the piriform fossa (n=22). Dimension Right side (n=22) Left side (n=22) Height 25 ± 0.5 mm 25.3 ± 1.3 mm Width * 14.2 ± 0.5 mm 15.1 ± 0.7 mm Thickness * 12.6 ± 0.5 mm 13.3 ± 0.4 mm * Significance, p > 0.05. Discussion The knowledge of laryngeal anatomy has a range of applications including in clinical practice when we examine a patient to make a diagnosis, and whenever he carries out treatment in the form of a manipulation or an operation as well as for professionals (such as singers) when a speech therapist can explore the relevant anatomy for voice training. 10 The increasing frequency of surgical, radiological, and electrophysiological procedures performed over the larynx has led to the importance of anatomical dimensions of the larynx and its cartilages. 9 , 11 It cannot be overstated that morphometric data are essential, and there is depth knowledge that can facilitate procedures such as intubation, stenting, and endoscopic procedures of the upper aerodigestive tract. 12 The measurements of cartilages of the larynx are also essential to manage the subglottic and post-intubation stenosis of the lower respiratory tract. 13 The morphometry of the cartilages of the larynx can also be enlightening in the planning of surgical interventions of the larynx. It also has implications for placing the electrodes during the electromyography of the larynx and the interpretation of CT and MRI scans of the larynx. 9 Studies on laryngeal cartilage measurements have proven to be a boon in the fields of laryngeal anthropometry, physiology, imaging, and surgery. Hajiiannaou et al . 14 reported that a rotated thyroid cartilage with a dislocated superior cornu protruding in the pyriform fossa of the same side may lead to globus pharyngeus, dysphagia, and odynophagia, thereby stressing the importance of laryngeal symmetry. Eckel et al . 9 reported the average height of thyroid lamina to be 27.4 ± 2.47 mm over the right and 27.6 ± 2.32 mm over the left side in adult male cadavers. In the same study the average measurements in females were 22.2 ± 2.85 mm over the right side and 22.1 ± 2.67 mm over the left side, which was seen to be a little less. In a study conducted by Zrunek et al ., 15 there was a 10% to 30% increase in the dimensions of laryngeal cartilage in males when compared to females. Park et al . 16 reported that the dimensions of the thyroid cartilage can assist in sex determination. Similar findings have also been reported by Ajmani et al . 17 and Lang et al . 18 In a study done by Jain and Dhall, 11 most of the dimensions of the thyroid and cricoid cartilage were higher in males than in females. They also reported obliquity of the thyroid laminae in both the sagittal and horizontal planes, thereby contributing to the increased angulation in females. They also observed asymmetry in the thyroid angle in 25% of the specimens, which deviated on either the right or left side. Kaur et al ., 19 in a study conducted in 30 cadaveric adult larynges, reported similar findings of increased parameters among men. The present study compared the data of the right and left thyroid cartilages. However, sex-based comparisons were not performed in our study. The dimensions of the epiglottis are essential for anesthesiologists and ear nose throat surgeons. The length and width of epiglottis in an infant has been reported to be 13.15 ± 0.44 mms and 8.92 ± 0.3 mms respectively. 20 The ultrasound thickness of epiglottis measured 2.4 ± 0.2 mm in a Chinese population. 21 According to American sonographic research by Werner et al ., 22 the epiglottic thickness was 2.39 ± 0.15 mm. The present study from the cadaver specimen reported a mean thickness of 2.6 ± 0.3 mm, which is similar to these reports. Werner et al . 22 endorsed that the epiglottis is thicker in the male than in other structures of the body. The present study could not perform a gender-based comparison, which is a limitation of this study. Morphometric dimensions of the piriform fossa are educative to doctors of anesthesiology and laryngeal surgery because this is the location of entrapment of foreign particles such as fish and chicken bones during eating. The foreign body must be removed endoscopically, as this may cause infection and difficulty in swallowing. The morphology of the piriform fossa is also important to determine its acoustic properties. 23 In this perspective, dimensions of the piriform sinus will help in the manufacture of the flexible fiber optic endoscopic instruments, which can match to that particular population. The present study provides morphometric data for the piriform sinus on the right and left sides. The length, width, and thickness are also provided. However, the data of the present study cannot be considered as a morphological database of our sample population, as the sample size was small. However, this sample size cannot represent the population subgroup of the entire country. Conclusions The present anatomical research presents the morphometric data of the thyroid cartilage, epiglottis, and piriform fossa in cadaveric samples of our sample population, which will help compare them with other populations. These data will guide the manufacture of endoscopic devices and endotracheal tubes with respect to our sample population. The height and thickness of the thyroid cartilage were greater on the right side than on the left side (p<0.05). It was statistically observed that the width and thickness were greater on the left side than on the right side (p<0.05). The data about the height, width and thickness of the thyroid cartilage, epiglottis and piriform sinus are essential during the laryngeal and other neck surgeries. They guide in the preoperative positioning, predicting the difficulty of intraoperative exposure and retractor pulling. However, the limitation of this study is the small sample size; the data will only be accurate with a larger sample size. Data availability Underlying data Figshare: Underlying data for ‘Morphometry of the thyroid cartilage, epiglottis and piriform sinus, an anatomical study’, https://doi.org/10.6084/m9.figshare.24455329.v1 Data are available under the terms of the Creative Commons Zero “No rights reserved” data waiver (CC0 1.0 Public domain dedication). References 1. Anson BJ, McVay CB: Surgical Anatomy. 5th ed.WB Saunders; 1971; 255. 2. Negus VE: The evidence of comparative anatomy on the structure of the human larynx. Proc. R. Soc. Med. 1937; 30 (11): 1394–1396. PubMed Abstract | Publisher Full Text | Free Full Text 3. Adamiec E, Dzięciołowska-Baran E, Czerwiński F, et al. : Prenatal development of the human trachea. Folia Morphol. (Warsz). 2002; 61 (2): 123–125. PubMed Abstract 4. Fayoux P, Marciniak B, Devisme L, et al. : Prenatal and early postnatal morphogenesis and growth of human laryngotracheal structures. J. Anat. 2008; 213 (2): 86–92. PubMed Abstract | Publisher Full Text | Free Full Text 5. Delvaux B, Howard D: A new method to explore the spectral impact of the piriform fossae on the singing voice: benchmarking using MRI-based 3D-printed vocal tracts. PLoS One. 2014; 9 (7): e102680. PubMed Abstract | Publisher Full Text | Free Full Text 6. Kitamura T, Honda K, Takemoto H: Individual variation of the hypopharyngeal cavities and its acoustic effects. Acoust. Sci. Technol. 2005; 26 (1): 16–26. Publisher Full Text 7. Standring S: Gray’s anatomy: the anatomical basis of clinical practice. 40th ed.London: Churchill Livingstone/Elsevier, London; 2008. 8. Guo YC, Tai SK, Tsai TL, et al. : Removal of unapproachable laryngopharyngeal foreign bodies under flexible videolaryngoscopy. Laryngoscope. 2003; 113 (7): 1262–1265. PubMed Abstract | Publisher Full Text 9. Eckel HE, Sittel C, Zorowka P, et al. : Dimensions of laryngeal framework in adults. Surg. Radiol. Anat. 1994; 16 (1): 31–36. Publisher Full Text 10. Davis EDD: The applied anatomy and physiology of the pharynx and oesophagus. Ann. R. Coll. Surg. Engl. 1948; 3 (3): 139–153. PubMed Abstract 11. Jain M, Dhall U: Morphometry of the thyroid and cricoid cartilages in adults on C.T. scan. J. Anat. Soc. Ind. 2010; 59 (1): 19–23. Publisher Full Text 12. Randestad A, Lindholm CE, Fabian P: Dimensions of the cricoid cartilage and the trachea. Laryngoscope. 2000; 110 (11): 1957–1961. PubMed Abstract | Publisher Full Text 13. Ajmani ML: A metrical study of the laryngeal skeleton in adult Nigerians. J. Anat. 1990; 171 : 187–191. PubMed Abstract 14. Hajiioannou JK, Florou V, Kousoulis P: Superior thyroid cornu anatomical variation causing globus pharyngeous and dysphagia. Case Rep. Med. 2010; 2010 : 142928. 15. Zrunek M, Happak W, Hermann M, et al. : Comparative anatomy of human and sheep laryngeal skeleton. Acta Otolaryngol. 1988; 105 (1-2): 155–162. PubMed Abstract | Publisher Full Text 16. Park DK, Kim DI, Lee UY, et al. : Morphometric analysis of the Korean thyroid cartilage for identification of sex: metric study. Korean J. Phys. Anthropol. 2003; 16 (3): 129–136. 17. Ajmani ML, Jain SP, Saxena SK: A metrical study of laryngeal cartilages and their ossification. Anat. Anz. 1980; 148 (1): 42–48. PubMed Abstract 18. Lang J, Fischer K, Nachbaur S: Uber Masse, Form und Formvarianten der Cartilagines thyreoidea et cricoidea [Measurements, form and form variants of the thyroid and cricoid cartilages]. Gegenbaurs Morphol. Jahrb. 1984; 130 (5): 639–657. 19. Kaur R, Kumar R, Laxmi V: The morphology and morphometry of adult human thyroid cartilage - a cadaveric study in North Indian population. CIB. Tech. Journal of Surgery (Online). 2014; 3 (1): 18–26. 20. Savkovic A, Delic J, Isakovic E, et al. : Age characteristics of the larynx in infants during the first year of life. Period. Biol. 2010; 112 (1): 75–82. 21. Chau CW, Chan HH, Wong CP, et al. : Sonographic measurement of the epiglottis in normal Chinese adults. Hong Kong J. Emerg. Med. 2010; 17 (5): 429–434. 22. Werner SL, Jones RA, Emerman CL: Sonographic assessment of the epiglottis. Acad. Emerg. Med. 2004; 11 (12): 1358–1360. PubMed Abstract | Publisher Full Text 23. Dang J, Honda K: Acoustic characteristics of the piriform fossa in models and humans. J. Acoust. Soc. Am. 1997; 101 (1): 456–465. PubMed Abstract | Publisher Full Text Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 19 Feb 2024 ADD YOUR COMMENT Comment Author details Author details 1 Department of Anatomy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India 2 Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, 462020, India Rajanigandha Vadgaonkar Roles: Project Administration, Supervision, Writing – Review & Editing Ashwin R. Rai Roles: Data Curation, Methodology, Writing – Review & Editing Chettiar Ganesh Kumar Roles: Data Curation, Writing – Review & Editing B.V. Murlimanju Roles: Formal Analysis, Writing – Original Draft Preparation, Writing – Review & Editing Mangala M. Pai Roles: Supervision, Writing – Review & Editing Latha V. Prabhu Roles: Supervision, Writing – Review & Editing Amit Agrawal Roles: Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (2) version 2 Revised Published: 15 Apr 2024, 13:115 https://doi.org/10.12688/f1000research.144481.2 version 1 Published: 19 Feb 2024, 13:115 https://doi.org/10.12688/f1000research.144481.1 Copyright © 2024 Vadgaonkar R et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Vadgaonkar R, Rai AR, Kumar CG et al. Morphometry of the thyroid cartilage, epiglottis and piriform sinus: An anatomical study [version 2; peer review: 2 approved, 1 approved with reservations] . F1000Research 2024, 13 :115 ( https://doi.org/10.12688/f1000research.144481.2 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 2 VERSION 2 PUBLISHED 15 Apr 2024 Revised Views 0 Cite How to cite this report: Charfeddine I and Chaabouni MA. Reviewer Report For: Morphometry of the thyroid cartilage, epiglottis and piriform sinus: An anatomical study [version 2; peer review: 2 approved, 1 approved with reservations] . F1000Research 2024, 13 :115 ( https://doi.org/10.5256/f1000research.164652.r292190 ) The direct URL for this report is: https://f1000research.com/articles/13-115/v2#referee-response-292190 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 15 Jul 2024 Ilheme Charfeddine , University of Sfax, Sfax, Tunisia Mohamed Amin Chaabouni , Department of otorhinolaryngology-Head and Neck Surgery, Habib Bourguiba Hospital (Ringgold ID: 518993), Sfax, Sfax, Tunisia Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.164652.r292190 Keywords: Add: epiglottis, thyroid cartilage Delete: endoscopy Introduction: Too much unnecessary detail, you need to be clear about the problematic that led to the study. Methods/Results: Specify whether measurements were made on male or ... Continue reading READ ALL Keywords: Add: epiglottis, thyroid cartilage Delete: endoscopy Introduction: Too much unnecessary detail, you need to be clear about the problematic that led to the study. Methods/Results: Specify whether measurements were made on male or female cadavers. Specify how epiglottis width was calculated: 1. In Figure 2, the width was measured from the right aryepiglottic fold to the left, which does not accurately represent the width of the cartilage itself. 2. Specify that this is the greatest width. 3 As shown in the figure, measurement after posterior opening of the cricoid cartilage may overestimate the exact width. This has different clinical implications Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Head and neck surgery We confirm that we have read this submission and believe that we have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however we have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Charfeddine I and Chaabouni MA. Reviewer Report For: Morphometry of the thyroid cartilage, epiglottis and piriform sinus: An anatomical study [version 2; peer review: 2 approved, 1 approved with reservations] . F1000Research 2024, 13 :115 ( https://doi.org/10.5256/f1000research.164652.r292190 ) The direct URL for this report is: https://f1000research.com/articles/13-115/v2#referee-response-292190 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Chauhan P. Reviewer Report For: Morphometry of the thyroid cartilage, epiglottis and piriform sinus: An anatomical study [version 2; peer review: 2 approved, 1 approved with reservations] . F1000Research 2024, 13 :115 ( https://doi.org/10.5256/f1000research.164652.r301063 ) The direct URL for this report is: https://f1000research.com/articles/13-115/v2#referee-response-301063 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 15 Jul 2024 Pradip Chauhan , Department of Anatomy, All India Institute of Medical Sciences, Rajkot, Gujarat, India Approved VIEWS 0 https://doi.org/10.5256/f1000research.164652.r301063 Authors have tried to cover all important aspect regarding the title. The results and discussion would be more valuable with the following added points. Result and analysis on the base of Gender of the cadaver. ... Continue reading READ ALL Authors have tried to cover all important aspect regarding the title. The results and discussion would be more valuable with the following added points. Result and analysis on the base of Gender of the cadaver. Consideration of the stature of the cadavers to minimize the compounding factors like height. Increasing the sample size to 30 Including the maximum diameter of the laryngeal inlet as a part of parameter Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Virtual reality, embryology, Gross human anatomy, medical education. digital health, artificial intelligence, Microgravity, histology, cardiovascular anatomy, neuroanatomy I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Chauhan P. Reviewer Report For: Morphometry of the thyroid cartilage, epiglottis and piriform sinus: An anatomical study [version 2; peer review: 2 approved, 1 approved with reservations] . F1000Research 2024, 13 :115 ( https://doi.org/10.5256/f1000research.164652.r301063 ) The direct URL for this report is: https://f1000research.com/articles/13-115/v2#referee-response-301063 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Version 1 VERSION 1 PUBLISHED 19 Feb 2024 Views 0 Cite How to cite this report: de Mendonça DMF and Aragão JA. Reviewer Report For: Morphometry of the thyroid cartilage, epiglottis and piriform sinus: An anatomical study [version 2; peer review: 2 approved, 1 approved with reservations] . F1000Research 2024, 13 :115 ( https://doi.org/10.5256/f1000research.158285.r252283 ) The direct URL for this report is: https://f1000research.com/articles/13-115/v1#referee-response-252283 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 28 Mar 2024 Deise Maria Furtado de Mendonça , Morphology, Federal University of Sergipe (Ringgold ID: 74391), São Cristóvão, State of Sergipe, Brazil José Aderval Aragão , Universidade Federal de Sergipe, São Cristóvão, State of Sergipe, Brazil Approved VIEWS 0 https://doi.org/10.5256/f1000research.158285.r252283 We conducted a thorough review of the manuscript titled "Morphometry of the thyroid cartilage, epiglottis, and piriform sinus: An anatomical study." The study aimed to determine the dimensions of the thyroid cartilage, epiglottis, and piriform sinus in embalmed cadavers from ... Continue reading READ ALL We conducted a thorough review of the manuscript titled "Morphometry of the thyroid cartilage, epiglottis, and piriform sinus: An anatomical study." The study aimed to determine the dimensions of the thyroid cartilage, epiglottis, and piriform sinus in embalmed cadavers from an Indian sample population. The paper offers a detailed morphological and morphometric analysis and establishes significant clinical correlations. The findings are valuable for professionals in various fields, including otolaryngologists, oncologists, intensive care physicians, anesthesiologists, speech therapists, and phoniatricians, as well as for comparisons with studies in other populations. The results are succinct, and the discussion section effectively places the findings in the context of existing literature. Unfortunately, a comparative analysis between males and females was not feasible, as acknowledged by the authors themselves as a study limitation. Nevertheless, the absence of this comparison does not diminish the significance of the presented data. Some minor points for improvement include: - Correcting the word "width" in the description of Figure 2. - The conclusions should address the differences between the right and left sides in terms of length, width, and thickness, and clinically discuss the implications of these measurements. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Clinical Anatomy and Medicine We confirm that we have read this submission and believe that we have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT de Mendonça DMF and Aragão JA. Reviewer Report For: Morphometry of the thyroid cartilage, epiglottis and piriform sinus: An anatomical study [version 2; peer review: 2 approved, 1 approved with reservations] . F1000Research 2024, 13 :115 ( https://doi.org/10.5256/f1000research.158285.r252283 ) The direct URL for this report is: https://f1000research.com/articles/13-115/v1#referee-response-252283 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 19 Jun 2024 B.V. Murlimanju , Department of Anatomy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, 576104, India 19 Jun 2024 Author Response We thank the reviewer for the expert opinion. As per the suggestion, the conclusions were revised. The typographical error was corrected. Competing Interests: No competing interests were disclosed. We thank the reviewer for the expert opinion. As per the suggestion, the conclusions were revised. The typographical error was corrected. We thank the reviewer for the expert opinion. As per the suggestion, the conclusions were revised. The typographical error was corrected. Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 19 Jun 2024 B.V. Murlimanju , Department of Anatomy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, 576104, India 19 Jun 2024 Author Response We thank the reviewer for the expert opinion. As per the suggestion, the conclusions were revised. The typographical error was corrected. Competing Interests: No competing interests were disclosed. We thank the reviewer for the expert opinion. As per the suggestion, the conclusions were revised. The typographical error was corrected. We thank the reviewer for the expert opinion. As per the suggestion, the conclusions were revised. The typographical error was corrected. Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 19 Feb 2024 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 3 Version 2 (revision) 15 Apr 24 read read Version 1 19 Feb 24 read Deise Maria Furtado de Mendonça , Federal University of Sergipe (Ringgold ID: 74391), São Cristóvão, Brazil José Aderval Aragão , Universidade Federal de Sergipe, São Cristóvão, Brazil Pradip Chauhan , All India Institute of Medical Sciences, Rajkot, India Ilheme Charfeddine , University of Sfax, Sfax, Tunisia Mohamed Amin Chaabouni , Habib Bourguiba Hospital (Ringgold ID: 518993), Sfax, Tunisia Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Charfeddine I et al. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 15 Jul 2024 | for Version 2 Ilheme Charfeddine , University of Sfax, Sfax, Tunisia Mohamed Amin Chaabouni , Department of otorhinolaryngology-Head and Neck Surgery, Habib Bourguiba Hospital (Ringgold ID: 518993), Sfax, Sfax, Tunisia 0 Views copyright © 2024 Charfeddine I et al. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Keywords: Add: epiglottis, thyroid cartilage Delete: endoscopy Introduction: Too much unnecessary detail, you need to be clear about the problematic that led to the study. Methods/Results: Specify whether measurements were made on male or female cadavers. Specify how epiglottis width was calculated: 1. In Figure 2, the width was measured from the right aryepiglottic fold to the left, which does not accurately represent the width of the cartilage itself. 2. Specify that this is the greatest width. 3 As shown in the figure, measurement after posterior opening of the cricoid cartilage may overestimate the exact width. This has different clinical implications Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Head and neck surgery We confirm that we have read this submission and believe that we have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however we have significant reservations, as outlined above. reply Respond to this report Responses (0) Charfeddine I and Chaabouni MA. Peer Review Report For: Morphometry of the thyroid cartilage, epiglottis and piriform sinus: An anatomical study [version 2; peer review: 2 approved, 1 approved with reservations] . F1000Research 2024, 13 :115 ( https://doi.org/10.5256/f1000research.164652.r292190) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-115/v2#referee-response-292190 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Chauhan P. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 15 Jul 2024 | for Version 2 Pradip Chauhan , Department of Anatomy, All India Institute of Medical Sciences, Rajkot, Gujarat, India 0 Views copyright © 2024 Chauhan P. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Authors have tried to cover all important aspect regarding the title. The results and discussion would be more valuable with the following added points. Result and analysis on the base of Gender of the cadaver. Consideration of the stature of the cadavers to minimize the compounding factors like height. Increasing the sample size to 30 Including the maximum diameter of the laryngeal inlet as a part of parameter Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Virtual reality, embryology, Gross human anatomy, medical education. digital health, artificial intelligence, Microgravity, histology, cardiovascular anatomy, neuroanatomy I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Chauhan P. Peer Review Report For: Morphometry of the thyroid cartilage, epiglottis and piriform sinus: An anatomical study [version 2; peer review: 2 approved, 1 approved with reservations] . F1000Research 2024, 13 :115 ( https://doi.org/10.5256/f1000research.164652.r301063) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-115/v2#referee-response-301063 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Aragão J et al. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 28 Mar 2024 | for Version 1 Deise Maria Furtado de Mendonça , Morphology, Federal University of Sergipe (Ringgold ID: 74391), São Cristóvão, State of Sergipe, Brazil José Aderval Aragão , Universidade Federal de Sergipe, São Cristóvão, State of Sergipe, Brazil 0 Views copyright © 2024 Aragão J et al. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions We conducted a thorough review of the manuscript titled "Morphometry of the thyroid cartilage, epiglottis, and piriform sinus: An anatomical study." The study aimed to determine the dimensions of the thyroid cartilage, epiglottis, and piriform sinus in embalmed cadavers from an Indian sample population. The paper offers a detailed morphological and morphometric analysis and establishes significant clinical correlations. The findings are valuable for professionals in various fields, including otolaryngologists, oncologists, intensive care physicians, anesthesiologists, speech therapists, and phoniatricians, as well as for comparisons with studies in other populations. The results are succinct, and the discussion section effectively places the findings in the context of existing literature. Unfortunately, a comparative analysis between males and females was not feasible, as acknowledged by the authors themselves as a study limitation. Nevertheless, the absence of this comparison does not diminish the significance of the presented data. Some minor points for improvement include: - Correcting the word "width" in the description of Figure 2. - The conclusions should address the differences between the right and left sides in terms of length, width, and thickness, and clinically discuss the implications of these measurements. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Clinical Anatomy and Medicine We confirm that we have read this submission and believe that we have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (1) Author Response 19 Jun 2024 B.V. Murlimanju, Department of Anatomy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, 576104, India We thank the reviewer for the expert opinion. As per the suggestion, the conclusions were revised. The typographical error was corrected. View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern de Mendonça DMF and Aragão JA. Peer Review Report For: Morphometry of the thyroid cartilage, epiglottis and piriform sinus: An anatomical study [version 2; peer review: 2 approved, 1 approved with reservations] . F1000Research 2024, 13 :115 ( https://doi.org/10.5256/f1000research.158285.r252283) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-115/v1#referee-response-252283 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. 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