Chondrolaryngoplasty in transgender women: Prospective analysis of voice and aesthetic satisfaction

Abstract

Introduction: Chondrolaryngoplasty or "tracheal shaving" is cosmetic surgery to reduce the laryngeal prominence in transgender women. Complications may include damage to the vocal folds and epiglottic destabilization or aesthetic dissatisfaction. Objective: To assess and compare acoustic and perceptual voice outcomes and aesthetic satisfaction of transgender women submitted to chondrolaryngoplasty. Methods: Prospective interventional cohort of transgender women submitted to chondrolaryngoplasty between March 2018 and October 2019. Voice analysis included simple-blind application of the GRBAS Hirano scale by speech therapist and measurement of the fundamental frequency, in the preoperative and 1-month postoperative periods. The visual analog scale was used to analyze the aesthetic satisfaction, before and 6-months after chondrolaryngoplasty. Results: Fifteen patients participated, with a mean age of 31.7 ± 8.3 years (range 22-51 years). The mean postoperative follow-up period was 15.3 ± 6.1 months (range 6-25 months). There was a significant improvement in the visual analog scale for aesthetic satisfaction, with a preoperative mean = 0.7 ± 1.0 and a postoperative mean = 9.3 ± 1.1 (95% CI for difference = 7.3 to 9.6; p < 0.001). All patients presented a positive variation. The preoperative mean fundamental frequency was 171.3 ± 41.2 Hz and the postoperative, 177.1 ± 39.5 Hz, with no statistical significance (95% CI for difference = -30.1 to 41.7; p = 0.74). There was no statistically significant difference in the pre- and postoperative comparison of each component of the GRBAS scale. One (7%) patient presented a hyperpigmented scar and 2 (13%) reported hoarseness during the first postoperative week. There were no major complications such as disinsertion of the epiglottis or vocal folds. Conclusion: Chondrolaryngoplasty led to significant aesthetic satisfaction in transgender women. The surgery caused no noticeable vocal change in pitch or perception.

Keywords: Sex reassignment procedures; surgery; thyroid cartilage; transgender persons; voice.

Figure 1.

Visual Analog Scale (VAS) for esthetic satisfaction of laryngeal prominence.

Figure 2.

Surgical steps. A: surgical positioning with a cushion under the shoulders and a head ring to support the head. B: marking the area of the thyroid cartilage to be resectioned, 3 mm away from the midpoint of the cartilage height. C: cartilage appearance after resectioning the prominence. D: smoothing and flattening of the edges of the remaining thyroid cartilage. E: resected portion of the thyroid cartilage, in a “V” shape. F: immediate postoperative aspect of the surgical wound, in profile.

Figure 3.

On the left, preoperative skin demarcation: thyroid notch (1), incision line (2) and upper and lower edges of the cricoid cartilage (3). On the right, detail of the marking the area of the thyroid cartilage to be resectioned, 3 mm away from the midpoint of the cartilage height.

Figure 4.

Pre- and postoperative Visual Analog Scale. Abbreviations: VAS, Visual Analog Scale. Distribution of VAS grades for esthetic satisfaction, before (mean = 0.7 ± 1.0) and after surgery (mean = 9.3 ± 1.1). Difference of means = 8.6 ± 1.9 (p < 0.001; CI 95% 7.3–9.6).

Figure 5.

Photographs with profile and front views, preoperative (left) and six months after surgery (right), patient #1.

Figure 6.

Photographs with profile and front views, preoperative (left) and six months after surgery (right), patient #2.

Figure 7.

Photographs with profile and front views, preoperative (left) and six months after surgery (right), patient #3.

Figure 8.

Pre- and postoperative fundamental frequency. Abbreviations: F0, fundamental frequency; Hz, Hertz. Mean F0 (Hz): Preoperative = 171.3 ± 41.2 Hz, and postoperative = 177.1 ± 39.5 Hz. Each line represents 1 patient. Mean variation = 5.8 Hz ± 10.5 Hz (p = 0.74; CI 95% = −30.1 to 41.7).