Chondrolaryngoplasty Under General Anesthesia Using a Flexible Fiberoptic Laryngoscope and Laryngeal Mask Airway

Evaluating Patient Benefit From Laryngochondroplasty

“…The vocal folds attach to the thyroid cartilage inferior to the ventricular folds and consist of a musculomembranous portion within the anterior three-fifths of the cord and a cartilaginous portion within the posterior two-fifths of the cord, formed by the vocal process of the arytenoid cartilage. 7 As described by Wolfort and Parry, 1 Wolfort et al, 2 Conrad and Yoskovitch, 3 and Spiegel and Rodriguez, 4 care must be taken to only remove the cartilage superior to these attachments (Fig. 2).…”

“…As described above, the technique we use is similar to the one first described by Wolfort and Parry, 1 Wolfort et al, 2 Conrad and Yoskovitch, 3 and Spiegel and Rodriguez. 4 Of note, the first couple of laryngoplasties were performed similar to how Conrad and Yoskovitch described, with the patient intubated and utilization of a laryngoscope to visualize the needle position as it is inserted into the airway. 3 Those cases required more time in comparison to the technique Spiegel and Rodriguez described using a fiberoptic scope through an LMA, and this was adopted as the standard technique for all patient in this study.…”

“…3 Those cases required more time in comparison to the technique Spiegel and Rodriguez described using a fiberoptic scope through an LMA, and this was adopted as the standard technique for all patient in this study. 4 It is essential to ascertain the position where the vocal folds, epiglottis, and false vocal folds attach to the thyroid cartilage to preserve their attachment and not damage them intraoperatively, as separating the attachment would affect the patient's voice and swallowing.…”

“…Most of our patients were young, with an average age of 31.4 years, and did not have many visible wrinkle lines in the neck, making it difficult to hide the incision in a skin crease per Wolfort et al 2 However, by placing the incision closer to the cervicomental angle, it would be less visible than making the incision more inferiorly closer to the laryngeal prominence of the thyroid cartilage. 3,4 The farther the incision is from the laryngeal prominence, the more technically challenging the surgery is because of surgical access. Sometimes the incision length would be increased from 2 cm to 2.5 or 3 cm if surgical access was difficult.…”

“…Laryngochondroplasty, also known as chondrolaryngoplasty, tracheal shave, or Adam's apple reduction is a surgical procedure to reduce the prominence of the thyroid cartilage in male-to-female transgender individuals. After being first described by Wolfort and Parry 1 and Wolfort et al 2 in 1975, various modifications of laryngochondroplasties have been described, including an endoscopic technique, to evaluate the position of the vocal folds by Conrad and Yoskovitch in 2003, 3 a technique using a fiberoptic scope through a laryngeal mask airway (LMA) by Spiegel and Rodriguez in 2008, 4 and a transoral approach by Khafif et al in 2020. 5 Although laryngochondroplasties have been performed for the last 40 years, few studies have been performed that evaluate the improvement in quality of life (QOL) after such procedures.…”