The trans-cervical plane (TCP): A new anatomical landmark for minimally invasive neck surgery

ABSTRACT

The currently used subdivisions of the neck are not helpful in neck surgery. In addition, the wide use of minimally invasive neck surgery has made it necessary to find reference points that make these procedures easier and safer. Here, clinical, anatomical and radiological study was undertaken to determine the relationships between the trans-cervical plane (TCP) and important neck structures. One hundred and ninety healthy volunteers were examined to determine the surface anatomy of the TCP together with 17 CT scans on the same plane and, five cadavers were dissected in an attempt to describe the anatomy of the mid-cervical region. The distance between the submental point and the sternal notch was measured, and the important anatomic features at this level were recorded. The anatomical location of the TCP was confirmed. TCP was opposite to the lower border of thyroid cartilage in 90% of the cases, and in 10% it was at the cricothyroid membrane. The average distance from the submental point to the TCP in the hyperextended neck was (6.5-11.5 cm). In spite of the wide range of variation of the distance between the submental point and sternal notch (13-23 cm), the middle of this distance is constant and often related to important anatomical structures the junction between the upper 1/3 and lower 2/3 of the thyroid lobes, superior parathyroid, and the body of the 6th cervical vertebra. It is concluded that the trans-cervical plane is an important landmark in the neck region that enables accurate and rapid localization of the cricothyroid membrane for emergency cricothyroidotomy and the tracheal rings for percutaneous dilatational tracheostomy and provides a reference point to mark skin incisions necessary for minimally invasive neck surgery (AU)

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