Chondrolaryngoplasty with Endoscopic Direct Visualization of the Vocal Cords: Demonstration of Technique.

Abstract

Summary: Chondrolaryngoplasty is a surgical procedure that reduces a prominent thyroid cartilage. Demand for chondrolaryngoplasty has significantly increased over recent years in transgender women and nonbinary individuals and has been shown to alleviate gender dysphoria and improve quality of life. When performing chondrolaryngoplasty, surgeons must carefully balance the desire for maximal cartilage reduction with the potential for damage to surrounding structures (ie, the vocal cords) that may result because of overaggressive or imprecise resection. Our institution has adopted the technique of direct vocal cord endoscopic visualization using a flexible laryngoscope for increased safety. Briefly, surgical steps include dissection and preparation for translaryngeal needle placement, endoscopic visualization of the needle placed above the level of the vocal cords, marking of the corresponding level, and resection of the thyroid cartilage. The following article and supplemental video provide further detailed descriptions of these surgical steps as a resource for training and technique refinement.

Finesse in Chondrolaryngoplasty

“…Although a higher incision has been described, the procedure is most commonly described with an incision at the cervicomental junction. 4 , 5 However, a prominent scar at the cervicomental junction can be a visible reminder of the patient’s surgical transition. We suggest placing an incision in the submental region, similar to the incision for a chin implant or neck tightening during a facelift.…”

“…Cartilage historically has been removed via rongeur, scalpel, electrocautery, or powered drill. 1 , 5 The use of a diamond burr to better shape ossified cartilage has been applied in recent years, 9 but can inadvertently damage surrounding soft tissue.…”