Adam’s apple reduction in transgender patients who are transitioning from male to female produced significant benefit for the patients, according to findings presented at the 2022 Triological Society Combined Sections Meeting in January. The presentation was titled, “Evaluating Patient Benefit from Laryngochondroplasty,” and was the 2020 Triological Society Thesis with Distinction Award winner.
Explore This IssueMarch 2022
Also known as laryngochondroplasty, or tracheal shave, the procedure to reduce the prominence of the thyroid cartilage was described at least as early as 1975, and new approaches have been developed over time, said Christopher Tang, MD, a head and neck surgeon at Kaiser Permanente in San Francisco. In the procedure (Arch Otolaryngol Head Neck Surg. 2008;134:704- 708) used in this study (Laryngoscope. 2020;1305:S1-S14), surgeons used a flexible fiberoptic laryngoscope and a laryngeal mask airway. The technique involves making an incision at the cervicomental angle, elevating the subplatysmal flaps, and dividing the strap muscles to expose the thyroid cartilage.
“There are a lot of very important structures that attach to the thyroid cartilage—the epiglottis, the false vocal cords, the true vocal cords—so it’s very important to remove only the cartilage superior to all the attachments,” he said. To help with this, Dr. Tang said, he placed an 18-gauge needle through the thyroid cartilage into the airway, visualizing the needle through the laryngeal mask airway with the flexible endoscope. He could see the needle emerging at the level of the vocal fold, and then knew that removing cartilage above that point was safe.
There are a lot of very important structures that attach to the thyroid cartilage— the epiglottis, the false vocal cords, the true vocal cords—so it’s very important to remove only the cartilage superior to all the attachments. —Christopher Tang, MD
From April 2016 to April 2020, a total of 209 patients received an Adam’s apple reduction procedure in the Kaiser Permanente system, and Dr. Tang performed the procedure in 91 of those cases. After the surgery, he gave the patients the Glasgow Benefit Inventory (GBI) questionnaire to fill out, and 73 of the patients did so.
The patients were an average of 31 years old at the time of the surgery, and waited 96 days, on average, for the surgery to be performed. They traveled an average of 45 miles for the surgery; more than 10 of the patients drove more than 100 miles for the procedure. The group was also racially diverse, with 16.5% Asian, 23.1% Hispanic, 57.1% White, and 3.3% Black.