ABEA017 - Longitudinal Analysis Of Swallowing Displacement Kinematics And Functional Swallowing Outcome Measures After Oropharyngeal Cancer Treatment
Friday, April 29, 2022
3:48 PM – 3:54 PM CT
Location: Landmark D
Joseph G Kidane, Joey Laus, Arushi Gulati, Grant E Gochman, Sarah L Schneider, Jason W Chan, Sue S Yom, Patrick K Ha, William R Ryan, Yue Ma
University of California, San Francisco School of Medicine; University of California, San Francisco Department of Otolaryngology-Head and Neck Surgery; University of California, San Francisco Department of Radiation Oncology
Medical Student University of California- San Francisco San Francisco, California
Objective: Transfeminine women (transwomen assigned male at birth) often undergo chondrolaryngoplasty (“tracheal shave”) to feminize their neck appearance. While isolated cases of vocal complications such as anterior commissure dislocation have been reported following the procedure, aggregated outcomes have not been quantitatively studied. We present acoustic and stroboscopic data to describe a patient cohort with vocal complications after chondrolaryngoplasty and discuss reparative surgical technique.
Method: Patients with voice complaints after chondrolaryngoplasty were evaluated with videostroboscopy in a trans voice referral center. Acoustic data were collected and assessed, along with self-assessment of vocal femininity. Dislocated anterior commissures were reconstructed with feminization laryngoplasty. Postoperative voice data were recorded and statistically compared to preoperative data using paired t-tests.
Results: On consecutive chart review, of the 94 transfeminine women with prior outside history of feminizing chondrolaryngoplasty, 27 (29%) reported chronic postoperative hoarseness, deepened pitch, or loss of upper register. On endoscopy, short, lax vocal folds with persistent anterior glottic gap and phase asymmetry were commonly noted; anterior commissure dislocation was confirmed in-office by using anterior commissure needle localization through absent thyroid cartilage. After open resuspension of the anterior commissure with feminization laryngoplasty, post-repair modal-speaking, minimum, and maximum fundamental frequencies (F0) increased on average 7, 9, and 5 semitones, respectively (p < 0.01), when compared to pre-repair values. On average, perioperative maximum phonation time did not change significantly (p = 0.15). Average self-assessment of vocal femininity increased by 48% (p < 0.01).
Conclusion: Anterior commissure dislocation (detachment/loosening) should be suspected with signs of vocal impairment after cosmetic chondrolaryngoplasty. Following proper diagnosis, resuspension of the anterior commissure via feminization laryngoplasty approach can be an effective reparative technique.