Assessing the concern for airway complications introduced by Wendler's glottoplasty

Abstract

ObjectiveWendler's glottoplasty (WG) is a pitch‐elevating surgery performed by laryngologists providing gender‐affirming care. The surgery creates an anterior glottic web that could theoretically cause airway concerns, either perioperatively or at the time of future procedures; such concerns are not well‐described in the literature. We seek to assess surgeon opinions on airway concerns regarding WG.MethodA survey of laryngologists assessing opinions on airway considerations in glottoplasty.ResultsA total of 19 physicians responded, representing approximately 193 surgeries. 52.6% performed glottoplasty and the remainder responded based on experience with anterior glottic webs. Two perioperative airway complications were reported, both mild stridor that did not prevent same‐day discharge. No long‐term sequela was reported. All surveyed laryngologists endorsed an altered general anesthetic approach for future procedures, with 73.7% advocating for use of a smaller endotracheal tube. 72.2% did not have “major concerns” about future intubations, and only 5.3% thought the immediate risk of airway compromise was a “real concern.” 91.9% counsel their patients routinely but briefly on airway concerns. Open‐ended comments conveyed themes of concern for post‐operative disruption of the web more than of airway compromise.ConclusionBecause glottoplasty is performed in the anterior glottis and does not significantly impact airway patency, the risk of serious airway complications appears to be minimal. Laryngologists believe future intubations require a modified approach with a smaller tube, partly due to concern for glottic web trauma. Based on this pilot study, the topic deserves greater work to standardize care and anesthetic alterations for patients with WG.Level of Evidence5

Anesthesia for gender-affirming surgery: a practical review

“…These patients are often on strict vocal rest for up to 2 weeks. If patients have undergone anterior glottoplasty and need future surgery, it is recommended to use an ETT one full size smaller than the size predicted by the patient's sex assigned at birth [51 ▪ ].…”