Prevalence and clinical significance of the triticeal cartilage

Abstract

Objectives: The triticeal cartilage can be misidentified as an atheromatous plaque in the common carotid artery in radiological images. It is very important to correctly define these two structures and distinguish from each other. The aim of this study, therefore, was to investigate the shape, length, width and the anatomical position of the triticeal cartilage to prevent the interpretation of its presence as an atheromaous plaque or any other pathology located in the neck. Methods: This study was performed retrospectively on 200 CT images of adult patients (age≥20 years; 128 males, 72 females). The shape, size and localization of triticeal cartilage were examined and its prevalence was determined. Results: Triticeal cartilage was not present in 63 cases. It was present unilaterally in 42 cases and bilaterally in 95. The cartilage was located at the C4 level most frequently. The triticeal cartilage was identified under 7 types as circle, double circle, oval, hook, ring, triangle and rod. Circle type was the most common. There was a statistically significant difference for the presence of ring type cartilage between males and females (p<0.05). Although the mean cartilage length and width were higher in males than females, this difference was not statistically significant (p>0.05). Conclusion: The presence of the triticeal cartilage should be considered in the diagnosis of atheroma in carotid arteries. In order to distinguish the triticeal cartilage from other surrounding structures, the shape, level and size of the cartilage must be known.

In reply to: what is new about triticeal cartilage?

“…Joshi et al [5] studied the triticeal cartilage on cadavers and classified the cartilage according to its shape as oval, circular, pyramidal, spindle and cylindrical. [5] However, as shown in the tables and figures of the study by Koca et al, [2] different types of triticeal cartilage were reported as hook, double circle and ring, which were not previously identified. These cartilages were named according to the shapes in which they were observed."Ring-shaped triticeal cartilage" was observed in 12 (7.19%) out of 167 males, while it was not detected in 65 females (p=0.02).…”

“…To sum up, triticeal cartilage variations were investigated more comprehensively and new shapes of cartilages were added to the already known types by Koca et al [2] We suggest that histological studies in large series of cadavers will be more effective to identify new types and make comment on calcification status of triticeal cartilage.…”

“…The atheroma plaques are important to recognize since they have a potential risk of causing stroke and can easily be mixed with calcified triticeal cartilage during the evaluation of radiological images since they both have similar anatomical location. Triticeal cartilage measurements of Koca et al [2] were made on computed tomography images. The measurements made by Alqahtani et al [3] and Vatansever et al [4] were examined on computed tomography angiography and triticeal cartilage was classified according to its shape in a similar pattern.…”

“…These cartilages were named according to the shapes in which they were observed."Ring-shaped triticeal cartilage" was observed in 12 (7.19%) out of 167 males, while it was not detected in 65 females (p=0.02). [2] In the post hoc G-power analysis performed to determine the strength of this difference, the…”