An external landmark for the anterior commissure

Objective: The ability to predict the level of the true vocal cords based o n external landmarks is crucial to the success of many laryngeal surgical p rocedures. This study examines the reliability of one such landmark on the thyroid cartilage. Methods: Twenty-four cadaver larynges were examined. A p in was placed through the landmark best described as a small diamond shaped area of color change and surface depression along the anterior midline of each thyroid cartilage through which travels a very small unnamed artery. T he endolaryngeal position of the pin was checked with a flexible nasopharyn goscope. Results: In all 24 cadavers, the pin entered the larynx at the ant erior commissure, just above or at the level of the true vocal cords. Concl usions: This external landmark reliably predicts the position of the true v ocal cords. It serves as a useful adjunct to existing external landmarks us ed to direct thyroid cartilage cuts in laryngeal procedures.