Thyroid Cartilage Reduction

Joseph Chang

Research output: Chapter in Book/Report/Conference proceedingChapterpeer-review

Abstract

Thyroid cartilage reduction, also known colloquially as a “tracheal shave,” reduces the prominence of the thyroid notch or Adam’s apple. It may be performed in conjunction with gender-affirming voice surgery and has been shown to be an effective adjunct to improve quality of life in transgender women. First described in 1975, thyroid cartilage reduction has more recently undergone modifications involving the use of intraoperative endoscopic guidance to improve safety and surgical outcomes. Prior to surgery, careful counseling regarding expected surgical outcomes is paramount. The degree of safe cartilage removal is limited by the level at which the vocal folds attach to the thyroid cartilage. Therefore, intraoperatively the key step is accurate identification of the location of the anterior commissure attachment. Thyroid cartilage must be removed up to this point and no further to maximize the degree of thyroid prominence reduction but avoid vocal fold detachment and subsequent postoperative dysphonia. Anatomic landmark-based methods have been found to be inaccurate in the majority of patients. Therefore, endoscopic confirmation of anterior commissure location should be performed in every patient. Postoperative care is focused on incision management and reduction of scarring. Voice change is not an intended outcome of this surgery, although some dysphonia may result from transient vocal fold edema.

Original languageEnglish
Title of host publicationVoice and Communication in Transgender and Gender Diverse Individuals
Subtitle of host publicationEvaluation and Techniques for Clinical Intervention
PublisherSpringer International Publishing
Pages217-223
Number of pages7
ISBN (Electronic)9783031246326
ISBN (Print)9783031246319
DOIs
StatePublished - 1 Jan 2023
Externally publishedYes

Keywords

  • Facial feminization
  • Gender-affirming surgery
  • Laryngochondroplasty
  • Thyroid cartilage reduction
  • Thyroid chondroplasty
  • Tracheal shave
  • Transgender care

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